Implementing quality indicators through clinician and patient online toolkits to improve rehabilitation care and outcomes after hip and knee replacement for osteoarthritis

Each year, more than 18,000 British Columbians have joint replacement surgery for hip or knee osteoarthritis. Many face challenges in getting timely, quality rehabilitation before, and especially after surgery. I have developed quality indicators that set minimum standards of rehabilitation care for joint replacements. Focusing on 10 of these quality indicators for care after surgery, my team of clinicians, patients and researchers have created online toolkits to help make these indicators available to patients and clinicians who provide joint replacement rehabilitation in BC. The toolkits contain resources such as checklists, videos, and posters. After first testing our study procedures, I will run a study to see if the toolkits make a difference in overall quality of rehabilitation care and lead to better experiences and results for patients. Patients, clinicians and those who make decisions about healthcare services, will be part of every stage of this work. I will share my findings widely to researchers, clinicians and patients locally and across Canada. This research will lead to better, more consistent care for patients and improve the joint replacement rehabilitation services available in BC.

Delineating the pathophysiology of hypoxic ischemic brain injury after cardiac arrest to identify therapeutic targets

The main determinant of patient outcome following revival from cardiac arrest (heart stops pumping blood and oxygen to the body) is the brain injury that occurs in the days after hospital admission. This injury, termed hypoxic ischemic brain injury, partly arises from a lack of oxygen delivery to the brain after resuscitation. The cornerstone of post-cardiac arrest management has involved increasing the delivery of oxygen to the brain to facilitate recovery.  This logic assumes that the transport of oxygen from the blood system into the brain tissue is normal after cardiac arrest. I have recently demonstrated that this assumption is not true and in fact, in a large proportion of post-cardiac arrest patients demonstrate an inability to unload oxygen into the brain from the blood vessels. The mechanisms explaining this observation are unclear and not accounted by tests including CT and MRI scans. Therefore, another approach is required.

My project involves using a series of novel blood tests that arise from structures in the brain that are responsible for oxygen transfer. Identifying the precise structures that inhibit oxygen delivery into the brain will lead to further research aimed at identifying therapeutic targets.

Informing the COVID-19 Response for Vancouver’s Urban Indigenous Population Using Community-driven Methods and Big Data Analytics

COVID-19 poses a significant threat to Urban Indigenous populations. To identify gaps and improve the response, Vancouver Coastal Health Aboriginal Health will use a community-driven approach to examine patient data collected within Vancouver health centres using the Vancouver Community Analytics Tool (VCAT), along with the advice of key urban Indigenous community organizations and stakeholders. Analyzed data will be used to develop an extensive data profile of Indigenous peoples who access care in the Vancouver region, including COVID-19 risk, comorbidities, and impacts to health service access. We will review the current Urban Indigenous COVID-19 response in Vancouver with existing networks to develop recommendations for BC that are driven by and for the Urban Indigenous community.

The implementation of an Indigenous cultural safety initiative within a large urban hospital in Vancouver, British Columbia

Co-leads:

Executive sponsor:

  • Patricia Daly
    VCH

Vancouver Coastal Health (VCH) Aboriginal Health is implementing an Indigenous Cultural Safety initiative with two units at Vancouver General Hospital (VGH) to improve the experience of Aboriginal patients and clients at VGH. The units, which include 350 VGH staff members, will complete a number of activities during March 2018 – March 2019.

This project will examine the implementation of the cultural safety initiative through a research team guided by two-eyed seeing, Indigenous cultural principles and implementation science frameworks for the purpose of guiding future spread of cultural safety training across diverse health authority settings.

The learnings from this pilot project will be used to spread the approach to other VGH departments and ultimately other hospital sites and facilities across BC. A number of hospital-wide and unit-specific activities will be piloted, falling into four streams:

  • Creating a welcome space: Visible acknowledgements of local First Nations (artwork, signage, booth displays etc).
  • Culturally competent VGH staff: Three hours Indigenous Cultural Safety training, 30 minute education sessions, monthly presentations by local chiefs, staff learning resources, webinars, and creation of advocacy roles.
  • Cultural resources and policies: Communications, patient cultural safety/support, and traditions and protocols booklets.
  • Access to cultural supports: Elders and Aboriginal patient navigators.

The indicators of success will be jointly developed in partnership with an Aboriginal advisory group to be convened at the conception of the study. It is key that the indicators of successful transformation reflect the needs of the Aboriginal patients served by the system. This will include indicators such as staff and patients reporting an observed change in the look and feel of VGH, improvement in cultural safety knowledge and understanding among VGH pilot unit staff level, staff perceptions of how practice will change as a result of attending training and education sessions, and staff perceptions of their ability to advocate for Aboriginal patient issues (allyship).

Vancouver community health research through an Indigenous lens: A collaborative learning workshop using two-eyed seeing

Co-leads:

  • Leslie Bonshor
    Vancouver Coastal Health
  • David Hall
    Vancouver Coastal Health
  • Michael Norbury
    Vancouver Coastal Health
  • Andrew Day
    Vancouver Coastal Health
  • Laurel Jebamani
    Vancouver Coastal Health
  • Krisztina Vasarheiyi
    Vancouver Coastal Health
  • Brittany Bingham
    Simon Fraser University

Trainee:

  • Teila Gabriel
    University of British Columbia
  • Andreas Pilarinos
    University of British Columbia

Indigenous peoples experience disproportionately poor health and social inequities as the direct result of Canada’s colonial history, including the Indian Act and Residential Schools. Indigenous people face discrimination in accessing health services and are often underrepresented in health research.

The Truth and Reconciliation Commission’s 94 Calls to Action demonstrate the need for system-wide transformation for creating Indigenous cultural safety within health systems. Call to Action 23 calls on all levels of government to improve cultural competency of healthcare professionals. Culturally safe care requires providers to understand how power dynamics created by colonization persistently affect Indigenous people’s health. The regional Aboriginal Health Program at Vancouver Coastal Health is leading innovative activities that use Indigenous methodologies to facilitate system-wide culture change, including cultural safety training at a large acute care facility, embedding Elders and Knowledge Keepers in care systems, and providing cultural practice guidelines to front-line staff.

A Two-Eyed Seeing research team will be formed to integrate Western and Indigenous perspectives on health research. The team will engage with Indigenous communities in three focus group sessions in fall 2018. Feedback will be provided on: respectfully conducting health research with/for Indigenous people; ways research can genuinely serve — not tokenize — communities participating in studies; and the health and wellness themes of highest priority to communities. Focus groups will be held with: (1) Indigenous women attending the Necamat Aboriginal Women’s Village of Wellness held in October in Vancouver’s Downtown Eastside; (2) Musqueam First Nation; and (3) Vancouver General Hospital Indigenous Peoples Advisory Group.

A knowledge translation team — consisting of (at least) one community representative, one knowledge user with knowledge translation expertise, and trainees — will synthesize community feedback to inform the development of content for Research Day and to produce a final report for knowledge dissemination.

The Research Day will be hosted by Vancouver Community health services at Vancouver Coastal Health in spring of 2019 to expand awareness of Indigenous perspectives on health and research among Vancouver Community staff. The morning will include a traditional opening by an Elder, a community panel discussion to explore themes of the focus group sessions, and a keynote presentation. Respected Indigenous leaders and researchers will speak and moderate discussions. In the afternoon, 25 registered Vancouver Community health researchers will attend a workshop on cultural safety and Indigenous research methods.

Implementing concussion return to activity guidelines in primary care

Throughout the history of medicine, patients who had a disease that was poorly understood were advised to rest. As scientists and doctors learned more, early mobilization and active therapies (e.g., exercise) gradually replaced rest as the conventional treatment for a variety of medical conditions, such as chronic fatigue, whiplash, stroke, low back pain, and cardiac arrest. We have now reached this same juncture for concussion care. The proposed project aims to figure out how to support doctors in implementing new science-informed return to activity guidelines for concussion.

By way of background, concussions (also known as mild traumatic brain injuries) are very common, affecting more than 20,000 people each year in British Columbia's lower mainland alone. Concussions have been historically treated with rest. An explosion of concussion research over the past decade has led to several important insights. One such insight is that resting for more than a few days does not speed up recovery, and in fact, may cause harm (for example, lead to social isolation and depression). There is also emerging evidence that exercise is an effective treatment. Guidelines for clinical care prepared by Canadian and international concussion experts now emphasize that patients should gradually return to activity (e.g., school, work, recreation) soon after injury, as tolerated. Nevertheless, rest remains the most common treatment prescribed by doctors. It is promoted in pamphlets and websites designed to educate patients about their injury.

The goal of the proposed research is to bridge the gap between concussion science and clinical care, and study how effective this knowledge translation effort is. We focus on family doctors because they are best positioned to counsel patients about returning to activity after concussion. We have assembled a package of knowledge translation strategies based on behaviour change theory, prior research on how to best implement new clinical care guidelines, and input from the kind of doctors and patients who could most benefit from this knowledge. The study plan involves learning about doctors' behaviour through an online survey tool each time they see a patient with a concussion, and measuring patient outcomes through telephone-based assessments. We will measure changes in how doctors manage concussions and whether those changes result in corresponding improvements in how quickly patients recover from a concussion.

Evaluation of Collaborative Practice Project

The focus of this evaluation program will be the impact of Collaborative Practice on three residential facilities: Banfield Pavilion, Evergreen House and Minoru Residence. Collaborative Practice Program has two key characteristics: 1) it is an approach to matching staff to patient needs through participation of nurses, unions, professional practice and clinical and operational leaders; 2) it promotes a team-oriented model of nursing care. The purpose of the evaluation will be to assess and compare the impact of the program at these three sites on health human resources and patient outcomes.

The evaluation of Collaborative Practice will include six main areas of focus:

  •     impact on clinical outcomes
  •     impact on health human resources
  •     nursing staff engagement
  •     consistent collaborative approach to care
  •     impact on clinician roles
  •     productivity

Development of a screening strategy for community-based adverse drug related events in the emergency department

Adverse Drug Related Events (ADREs) are the most common type of preventable non-surgical adverse event related to medical care, and represent a leading cause of death. Each year, in BC alone, Emergency Departments treat an estimated 130,000 patients for ADREs, most of which are caused by medications prescribed in community settings. Unfortunately, community-based programs aimed at detecting and reducing drug-related problems have not led to a significant decline in morbidity, mortality or health services utilization. Emergency Department practitioners are well situated to play a pivotal role in the timely recognition and treatment of community-based ADREs. Unfortunately, Emergency Physicians currently detect only 50% of ADREs, missing opportunities to intervene.

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The British Columbia Fatigue Research Group

This award funds the creation of a research team focused on understanding fatigue associated with neurologic and neuromuscular disorders. The goal is to develop an interdisciplinary approach to research, exploring the prevalence of fatigue among individuals with disabilities, how and to what extent the condition influences function and quality of life, what are the costs to society and the health system and, ultimately, how to improve treatment.

Centre for Complex Disorders

Serious mental disorders affect thinking, mood and behaviour. The consequences are suffering, impaired function in daily life and yearly costs estimated in Canada at tens of billions of dollars. Like diabetes, hypertension and asthma, mental disorders are complex disorders, meaning there is no single gene mutation, experience or environmental effect that can be held responsible. With a history of focused but isolated research strategies that have failed to address these complexities, present day treatments for schizophrenia and bipolar disorder are no more effective than those developed 50 years ago. There is also a lack of effective treatments for Alzheimer’s disease. The Centre for Complex Disorders (CCD) will seek integrative and transformative solutions to these health problems, with an initial focus on psychotic illnesses, such as bipolar disorder and some types of depression. These often begin in adolescence and cause those affected to lose contact with reality, and chronically become socially isolated and unable to work. The unit’s secondary focus will be complex disorders affecting memory in old age.

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