Building Capacity for Surveillance and Policy Development: Health Impact Assessments of Air Quality in Northern British Columbia

In Northern British Columbia, a region rich in natural resources, there has been a rapid expansion of resource extraction projects across the region in recent years. While generating economic growth for local communities, this has also led to concerns among health practitioners and community members about the potential health risks associated with declining air quality due to increased industrial emissions. In the BC Northwest, in particular, projections indicate that sulphur dioxide emissions will likely increase in the Kitimat airshed due to multiple new industrial projects and expansion of existing projects.Timely information about air quality and associated health risks is important for developing public health policies, to prevent potential negative health impacts, and for planning at both local and regional levels. The objectives of this project are to 1) conduct a health impact assessment of impacts of SO2 emissions on human health in the Kitimat region; 2) make recommendations for development of effective surveillance tools to assess air quality health impacts in the region; and 3) review how local and regional policy makers use environmental health impact information for decision-making.This project will directly support Northern Health's organizational impact goal of healthy people in healthy communities, through promoting and protecting healthy environments, and through helping to build regional capacity for conducting health impact assessments and surveillance.

Building on Strengths in Supported Housing and the Treatment of Mental Illness in BC

Research co-lead: 

  • Julian Somers
    Simon Fraser University, At Home Project, Homeless Intervention Program, Inter-Ministry Research Initiative 

Research user co-lead:

  • Darrell Burnham
    Coast Mental Health

Team members: 

  • David MacIntyre
    BC Non-Profit Housing Association
  • Dominic Flanagan
    BC Housing
  • Taryn Walsh
    Ministry of Mental Health & Addiction
  • Elenore Arend
    Ministry of Public Safety & Solicitor General
  • Colin Ross
    City of Vancouver, BC Justice Summit
  • Stefanie Rezansoff
    Simon Fraser University 

BC research has examined the effects of supported housing on mental illness, addiction, crime, public safety, community integration, quality of life, and total public expenditure. Local and international studies show that increased spending does not necessarily result in significant improvement for people with complex needs, and that effective interventions require specific coordinated approaches to service delivery. At present, no central source of support exists to ensure that relevant research is available to inform practices in BC.

This project will convene provincial partners who are responsible for addressing homelessness, mental illness, and addiction, and identify priorities for cross-sector coordination, implementation of best practices, and evaluation. Identified priorities will be reviewed with additional provincial stakeholders (e.g., municipal government, community-based housing & health service providers, patients & family members). Priorities and recommendations will be finalized by the project team along with recommended next steps and made available to the public via SFU web-based media and communications.

 Results will inform a multi-year plan for applied research addressing housing and mental illness in BC. 

Design and evaluation of an evidence-based exercise program to enhance protective responses for avoiding fall-related traumatic brain injury in older adults

Falls cause up to 80% of traumatic brain injuries (TBI) in older adults. Any fall from standing may cause TBI if head impact occurs. Humans use movement strategies to avoid head impact during falls, such as 'arresting' the fall with the arms. Through video capture of real-life falls, we found that these strategies persist but become less effective for older adults in long-term care, with over 1/3 of falls resulting in head impact in this setting. This project continues our work with Debbie Cheong (Osteofit Provincial Coordinator at BC Women's Health Centre) to design and evaluate novel exercise programs for enhancing protective responses for avoiding head impact in falls. We will identify the strength and flexibility demands of common safe landing strategies observed in falls in older adults, and design and evaluate feasible approaches to enhance those capacities for older adults of varying physical and cognitive status.

This project will lead to new evidence on the strategies that older adults use to avoid head impact during falls, and the musculoskeletal demands of those strategies; new exercise-based approaches for targeting and enhancing the effectiveness of fall protective responses in older adults; and evidence of the feasibility and effectiveness of our exercise program for older adults.

Value Judgments in Health Economics Modelling for Primary Care: Towards Patient and Public Partnership in BC

In scientific research, many decisions are needed. Some take scientific expertise, but others take knowing what people find important. Such 'value judgments' include: choosing a topic and how to study it, setting goals, and deciding how to share results.

Patients and the public can inform value judgments in research by being partners and sharing what is most important to them, including

  1. what is most important to know;
  2. what errors are most important to avoid.

This is necessary in health economics, the type of research that looks at health and costs as part of healthcare planning. This project will build on a study that asked health economists about value judgments, including whether and how value judgments in their studies could affect healthcare. In a new project, researchers will start a conversation with patients and the public about the same issue. First, they will create short videos about value judgments in research, including how health economists think about and manage them in their studies. Then, patients and the public who viewed the videos will be asked what they think. Could health economists do a better job of managing value judgments?

The study will help make sure health economics research in BC is clear, understandable, and done in partnership with patients and the public. It will help ensure that British Columbians' values are front and centre in research, including where to focus and how to manage possible errors in studies about healthcare.

Personalised tools and stimulations in rehabilitation: linking clinical measures of motor recovery and mobility post-stroke with gait performance and functional outcomes of an intervention

Stroke is the leading cause of disability in Canada with more than 400,000 Canadians living with long-term disorders due to stroke. Hence, whilst challenging, it is critical to restore mobility to these individuals such as independent walking; the most frequently stated goal of individuals post-stroke. However, achieving this goal is hindered by motor impairments, including muscle weakness and spasticity, yet we still do not understand how these impairments influence walking post-stroke. This lessens the efficacy of emerging innovative treatments such as the use of botulinum toxin or Botox to suppress spasticity and improve walking. Computer simulations are powerful tools to uncover how muscles coordinate movement and predict the functional gains following a personalised treatment plan.

This research aims to develop diagnostic tools that can be used in clinical practice to identify movement deficiencies during walking post-stroke and associate them with clinical measures of function and spasticity before and after an intervention. These tools will facilitate greater use of personalised therapies, one of the primary goals of stroke recovery in Canada, and ultimately give people with strokes the ability to walk independently.

Strengthening primary care through population-based research

Primary care includes the day-to-day services provided by family doctors, nurse practitioners, and other health care providers. High quality primary care that follows patients over time and coordinates specialist and hospital care is key to an effective and efficient health care system. Unfortunately, many Canadians struggle to get primary care where and when they need it, despite there being more family doctors per person than ever before.

My research program seeks to answer the following questions:

  1. How can we make sure we have the right number of health care providers to meet the needs of Canadians now and in the future?
  2. How can we efficiently organize delivery of primary care to meet the needs of patients? How do we improve access to effective care for underserved groups, including people managing both mental and physical health conditions and recent immigrants and refugees?

I analyse routinely collected data from health care delivery and look at the impact of policy changes using statistical models. I work in partnership with researchers who have complementary skills collecting information through interviews and focus groups. My research teams include patients, care providers, and people who plan health services.  This helps make sure we ask questions that matter and that research results will help change our health care system.

Preclinical development of a disease modifying small molecule therapy for Alzheimer disease

Dr. David Vocadlo is leading one of five BC researchers leading teams supported through the British Columbia Alzheimer’s Research Award. Established in 2013 by the Michael Smith Foundation for Health Research (MSFHR), Genome British Columbia (Genome BC), The Pacific Alzheimer Research Foundation (PARF) and Brain Canada, the goal of the $7.5 million fund is to discover the causes of and seek innovative treatments for Alzheimer’s disease and related dementias.

Alzheimer’s disease (AD) is a debilitating and progressive neurodegenerative disease, accounting for almost two-thirds of all dementias in Canada, and in BC affects up to 70,000 people. Symptoms include memory loss, behaviour and personality changes, and a decline in cognitive abilities.

Current AD medications treat symptoms of the disease, but none exist that can stop or even slow the progression of AD which starts in the brain many years before it manifests. The need for AD therapies that treat underlying progression of the disease is paramount for the aging population, in particular because of the projected increase in the number of AD patients.

Dr. David Vocadlo, a professor in Chemistry and Molecular Biology & Biochemistry and Canada Research Chair in Chemical Biology at Simon Fraser University (SFU), aims to address several key challenges that would clear the way for a promising new AD therapeutic target.

The two biological hallmarks of Alzheimer's disease in the brain, neurofibrillary tangles and amyloid plaques, are caused by the dysfunction and abnormal accumulation of specific proteins that can kill brain cells over time, progressively impairing brain function.

Vocadlo and a multidisciplinary group of research teams from SFU, the University of British Columbia (UBC) and the University of York in the UK, are pioneering their new approach that has been shown to block disease progression in animal models of AD by blocking the toxicity of the brain proteins that form the tangles within brains. Their approach centres on a specialized sugar unit called O-GlcNAc. Clumps of protein from AD brains have almost none of this sugar attached to them because the O-GlcNAcase enzyme continues to remove this sugar modification.

Vocadlo’s therapeutic goal is to use small molecules to block the activity of the O-GlcNAcase enzyme, and in this way increase the levels of O-GlcNAc in the brain to prevent this protein from clumping together and becoming toxic. Vocadlo’s team is currently advancing this therapeutic target in order to advance it into the clinic.

Implementation and evaluation of an enhanced PharmaNet-based adverse drug event reporting platform to improve patient safety and meet adverse drug reaction reporting requirements

MSFHR is contributing match-funding towards Dr. Ellen Balka’s research (co-led with Dr. Corinne Hohl, recent awardee of Clinician Scientist Award), one of 22 projects as part of the Canadian Institutes for Health Research (CIHR) eHealth Innovation Partnership Program (eHIPP). eHIPP was designed to address gaps in health care — including supporting seniors with complex care needs in their home — by stimulating collaborations between health researchers and Canadian innovative technology companies. Collaborators include Connected Displays, Vancouver Coastal Health, Provincial Health Services Authority and the BC Ministry of Health. Funding support is provided by the College of Pharmacists of BC and Lower Mainland Pharmacy Services. MSFHR is also funding the eHIPP research projects of Drs. Scott Lear and Kendall Ho.

Each year in British Columbia, adverse drug events (ADEs), the unintended harmful reactions to medication use, result in 240,000 emergency department visits and 480,000 hospital days, with their treatment adding $90 million to health care costs. Seniors, the highest users of medications, experience the greatest proportion of adverse drug events.

Up to 70 percent of ADEs have been identified as preventable, with 30 percent occurring when health care providers unknowingly re-prescribe and re-dispense drugs that had previously harmed patients. Current electronic systems are not effective in preventing the unintentional prescribing of culprit or contraindicated drugs as ADEs are often not documented in medical records, and not communicated between care providers and across health care sectors.

Dr. Ellen Balka, a communication and technology expert and professor at Simon Fraser University (SFU) and Dr. Corinne Hohl from the University of British Columbia’s (UBC) Department of Emergency Medicine and Vancouver General Hospital are leading the ActionADE project to reduce ADEs. The team will implement and evaluate an ADE reporting platform through PharmaNet — BC’s provincial drug billing system — and integrate into existing health care practices. The goal of the platform is to bridge current information gaps and address the need for improved communication of ADEs across health care settings and providers by generating real-time patient- and medication-specific alerts about previous ADEs for clinicians when prescribing or dispensing medications.

The project team, based at the Vancouver Coastal Health Research Institute’s Centre for Epidemiology and Evaluation, worked with industry partner PHEMI of Vancouver to develop the ActionADE software that will be used by hospital-based and family physicians, in-hospital and community-based pharmacists and other health care providers. Decision-making authorities, including government and researchers, will have access to the data generated. It is estimated the ActionADE platform will help avoid as many as one-third of the preventable ADEs, translating into more than 40,000 fewer ED visits, saving the provincial health care system as much as $18 million annually. 

In 2018, Hohl received a MSFHR Health Professional Investigator Award related to this project.

Moving beyond headcounts: improved physician workforce planning for primary care in BC

Consistent access to high-quality family medicine improves the health of the population and lowers the costs of health care. Reports of family medicine shortages and of difficulties in accessing family physicians are ubiquitous in British Colombia (BC). To address shortages and access challenges, the Ministry of Health needs a clear understanding of how many active family doctors are working within provincial borders, how many are providing comprehensive and patient-centered care, how they structure their practices, and how patients access (or do not access) the services they provide. 

The Ministry also needs a method to accurately estimate the future supply of family physicians and services in order to proactively design and implement policies that will address upcoming accessibility issues. These challenges are particularly salient given the upcoming rollout of team-based care across the province. 

To address these issues, this fellowship will integrate the results of several ongoing studies into a strategy for proactive physician workforce planning, supporting recruitment and retention efforts and the development and evaluation of new models of family medicine practice. It will provide granular data on the supply of comprehensive care, identify current and future gaps, and inform policy on training, recruitment and retention of family physicians. Ultimately, it will enhance the capacity for evidence-informed workforce planning within BC's Ministry of Health, leading to downstream improvements in access to family medicine across the province.

Learning from the lived experiences of aging immigrants

Co-leads:

  • Sharon Koehn
    Centre for Healthy Aging / Simon Fraser University
  • Kahir Lalji
    United Way of the Lower Mainland

Team members:

  • James Broesch
    Vancouver Coastal Health
  • Shari Brotman
    McGill University
  • Ilyan Ferrer
    University of Calgary
  • Krista James 
    BC Law Institute
  • Anthony Kupferschmidt
    West End Senior's Network

Trainee:

  • Laura Kadowaki
    PhD student

The research project — Intersectional identities and interlocking oppressions: Stories of the everyday among ethnocultural older adults in Canada — collected in-depth life stories and photographs from 19 immigrant older adults in British Columbia (BC) and Quebec. Participants are from immigrant populations (Korean, Filipino, Latin American, Caribbean, Afghani and Pakistani) where little research has been done in Canada, but have diverse backgrounds and journeys, and who have been marginalized. As a result of this project, a narrative photovoice exhibit has been made. The Lived Experiences of Aging Immigrants — presents both their challenges (e.g. trauma, discrimination, poverty, family disruption) and celebrations (e.g. building community, caring for family, faith, resilience). A key aim of the exhibit is to encourage knowledge exchange with service providers and policymakers.

This award will enable the team to present the exhibit to groups who are capable of making or influencing changes at the policy, practice and community level, and who can positively influence the determinants of health and aging for older immigrant adults.

The exhibit will be mounted in different spaces convenient to target groups, and will be a springboard for facilitated discussions where stakeholders will be encouraged to identify and prioritize the actions they can take to effect this change within their spheres of influence. For example, these groups may include senior peer support volunteers, population/community health specialists charged with delivering health promotion programs, or seniors rights advocates who lobby for changes to determinants of health such as housing and transportation. The discussions will encourage participants to take ownership of the initiatives they recommend. Research user team members served as advisory group members on the Intersectional identities project and are strategically situated in health and seniors care contexts in BC. They will identify and facilitate engagement with relevant groups. The Social Planning and Research Council of British Columbia will be engaged to organize and facilitate 10 such events. They will further work with this team to distill and prioritize feedback from all groups into clear recommendations. A final report and policy briefs directed at specific audiences will be generated.