A scoping review of literature on different models of allocating funds to facilitate integrated care

Jason Sutherland is Professor in UBC’s Centre for Health Services and Policy Research in the School of Population and Public Health. He is also a Scholar of the Michael Smith Foundation for Health Research.

This is a two-province research team, though the scope of the project is examining integrated funding models across the globe. Little is known regarding how other countries have developed and implemented policies for supporting integrated healthcare. This study will conduct an extensive review of the literature and synthesize the evidence regarding the scope and breadth of policies and their effectiveness to improve integration of healthcare across sectors of the delivery system.

Knowledge translation activities:

  • Policy roundtable to disseminate findings to knowledge users in Calgary, Alberta
  • Policy roundtable to disseminate findings to knowledge users in Vancouver, British Columbia
  • Patient Groups Compensation (honorarium, travel cost, parking) in Calgary, Alberta
  • Patient Groups Compensation (honorarium, travel cost, parking) in Vancouver, British Columbia
  • Open Access Publication jointly by University of Calgary and University of British Columbia
  • Webinar and YouTube video preparation by the University of British Columbia

The team expects to share findings of the project with key public stakeholders regarding attributes of policy and delivery systems that integrate sectors of the healthcare delivery system to improve care and outcomes.


End of Award Update – April 2022

Most exciting outputs

In my opinion, the most exciting outputs from this project include the development of a multi-institution collaborative to collect surgical patients’ health and health outcome information. The information that this project has generated has led to innovative insights into the value of operative treatment for the patient, health system and government. This information has led to creative ways of re-configuring access to elective surgery, improving mental health in addition to physical health, and training students on the importance of patients’ perceptions of their health.

Impact so far

The impact of this project is local, national and international. Locally, operative patients, the health system and the province are benefiting from understanding the gain in health attributable to surgery. Nationally, this work is garnering significant attention from outcomes researchers and health systems seeking to understand variability in health and healthcare outcomes from surgical care. Internationally, this work is attracting interest from countries with public health systems with similar problems in accessing surgical care and cost-efficiency of healthcare delivery, international agencies, such as the International Consortium for Health Outcomes Measurement (ICHOM), and academic institutions.

Potential future influence

The project is continuing to expand with financial and in-kind support from new organizations. In 2021, PHSA and the Heart and Stroke Foundation (B.C.) began funding the expansion of the project.

Next steps

  1. Continued expansion with existing and new collaborators.
  2. Renewed knowledge translation with government and healthcare organizations.
  3. Attract new funding from national and provincial research organizations.

Useful links

Scaling up Trauma and Violence Informed Outreach with Women Affected by Violence

This 7-year, multi-site implementation project is funded by the Social Science and Humanities Research Council of Canada (SSHRC), Partnership Grants competition. Through community-based research design and implementation we aim to address an urgent priority of providing access and receipt of services among women and youth affected by violence who experience the worst severity in terms of types, duration, frequency and impact of violence for their lives. This pan-Canadian team includes 31 co-investigators and 14 partner organizations, across academic, public service, not for profit and private organizations.

Together, this team will implement an innovative, trauma and violence informed approach to outreach and community service integration in 4 Canadian cities including two in BC, testing the efficacy of this model to positively impact women’s engagement with an array of health and social services that can help women recover from and prevent ongoing violence in women’s lives. Study outcomes will provide essential information about the current primary care services in the BC Sites, and offer evidence informed strategies with transferability within these and other BC locations to enhance primary care for vulnerable women.

Additionally, because our model includes an integrated service approach we will be investigating how not-for-profit service organizations navigate and collaborate with primary care services to support appropriate referral for the women to whom they provide services. This information can also support more effective collaborations between these two service provider sectors.

The principal investigator is Victoria Bungay, Associate Professor, School of Nursing, UBC-Vancouver and Canada Research Chair in Gender, Equity and Community Engagement. Other BC team members are:

  • Jennifer Baumbusch, School of Nursing, UBC-Vancouver
  • Aggie Black, Providence Health Care
  • Linda Dewar, Inner City Women’s Initiatives Society
  • Kasari Govender West Coast Legal Education and Action Fund (West Coast LEAF)
  • Kim Hawkins, Rise Women’s Legal Centre
  • Angie Lohr, H.O.P.E. Outreach in Kelowna
  • Karen Mason, Kelowna Women’s Shelter
  • Michelle Novakowski, Central Okanagan Elizabeth Fry Society (COEFS)
  • Will Panenka, Department of Psychiatry, UBC-Vancouver
  • Eli Puterman, School of Kinesiology, UBC-Vancouver
  • Paul Van Donkelaar, School of Health & Exercise Sciences, UBC-Okanagan

The team also includes an incredible advisory of women with expert knowledge in accessing supports and services within their respective communities.

Funding partners of the project

  • SSHRC Partnership Grant – $2,499,946 over 7 years
  • UBC (Vancouver & Okanagan) – $ 551,967 total contribution ($210,000 cash and $ 341,967 in-kind).
  • Anonymous donor: $350,000

The total 7-year commitment by all partners (including MSFHR), both cash and in-kind: $ 5,336,100

An Inter-provincial comparison of innovative programs that help individuals and families affected by life-limiting chronic illnesses navigate end-of-life

Dr. Kelli Stajduhar is working with a team of researchers across Canada including PI R. Urquart (NS), and Co-Is K. Pfaff (ON), G. Johnston (NS), B. Lawson (NS), C. Tschupruk (NS), and G. Warner (NS). MSFHR has contributed matched-funding to support the CIHR Strategy for Patient-Oriented Research funding. Using a realist evaluation, survey questionnaires, and in-depth interviews with program personnel, programs users and family members, this study will focus on gaining an improved understanding of innovative community-based navigation programs across Canada with a focus on end-of-life care and support.

Of particular interest are those programs that have been developed and successfully put into place across various health jurisdictions and which help educate patients and families, link them to critical health system and community services and supports, and facilitate coordination of services and supports across healthcare settings. Generally speaking, the programs of interest will help patients access the services and resources they need, though it's expected the way in which they do so will vary from program to program.

It will be examined 1) whether and how these navigation programs work across different community and health system contexts; and 2) what is needed to integrate successful community-based navigation programs into currently existing primary healthcare services and systems of care so they are sustainable, and can improve patient and family outcomes across Canadian jurisdictions and healthcare settings at the end-of-life.

Translating research into practice: Investigating the impact of Alzheimer’s disease diagnostics in Canada (IMPACT-AD)

Early and accurate diagnosis of Alzheimer’s disease is critical as timely access to health care and community services has the potential to slow disease progression and improve quality of life. Current approaches for diagnosis rely on traditional imaging tests and observation of the signs and symptoms of the disease. Adding the measure of proteins found in cerebrospinal fluid (biomarkers) has been shown to help correctly identify the disease and predict those with mild symptoms that are likely to progress to dementia; however, such testing is not readily available in Canada.

The IMPACT-AD study specifically addresses barriers to uptake and use of Alzheimer’s disease biomarker testing in the Canadian health care system. This Canada-wide study will develop a comprehensive understanding of how biomarkers for Alzheimer’s disease impact clinical decision making and health care costs. Collaborating with patients, caregivers, and physicians, IMPACT-AD will also investigate the effect of testing on personal decision-making. The findings of this study will lay the necessary groundwork, modernize, and improve the care available to Canadians affected by Alzheimer’s disease and related forms of dementia.

IMPACT-AD is led by Dr. Mari DeMarco, a clinical chemist at St. Paul’s Hospital, and a clinical associate professor in Pathology and Laboratory Medicine at UBC. DeMarco is joined by a multidisciplinary team that includes both Canadian and international laboratory medicine specialists, geriatricians, neurologists, health economists, rural/remote clinicians, ethicists, and statisticians.

IMPACT-AD is funded by the generous support of Brain Canada, Michael Smith Foundation for Health Research, UBC Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, and Women’s Brain Health Initiative; it is also being undertaken in collaboration with the Canadian Consortium on Neurodegeneration in Aging.

For more information about the study and how you can get involved, visit www.impactAD.org.


Award update: December 2021

Alzheimer’s test provides much needed answers to patients and their families
A new study gives Canadians the opportunity to test for the disease and provide their perspective on how the results impacted their lives.

Source: Brain Canada

Supporting integration through primary health care teams: A comparative policy analysis across four Canadian provinces

MSFHR is contributing match-funding towards Dr. Nelly Oelke’s research, awarded through SPOR Networks in Primary and Integrated Health Care Innovations – Provincial/ Territorial Comparative Program and Policy grant. Dr. Oelke is undertaking this pan-Canadian project across four provinces (BC, AB, ON, and QC) with a team of researchers including the following PIs: S. Montesanti (AB), S. Johnston (ON), and M. Breton (QC).

Primary health care (PHC) models in Canada continue to change. There are still many gaps in understanding what works and what doesn’t work for PHC teams, specifically, to promote integration and continuity of care for patients with complex needs (e.g. more than one chronic condition). The goal of this research is to study provincial and regional policy documents (guiding principles and courses of action) that support health services integration for patients with complex needs through PHC teams. Patient engagement in developing and applying policies will also be looked at.

This study will include three phases.

  • Phase 1: Collecting and analyzing all policy documents from the four provinces. Individual case reports will be developed and then policies will be compared across provinces.
  • Phase 2: Patient interviews from each province and then a disussion session with those patients to review the results and come up with an action plan.
  • Phase 3: Feedback will be gathered through online and web-based discussions from a broad group of provincial and national stakeholders including patients. These stakeholders will be asked to develop recommendations and actions based on the research results.

The results of this study will provide a better understanding of BC’s current policies for PHC teams, and how these support or create barriers to integrated health services delivery. It will also provide a better understanding of how BC patients and caregivers are involved in developing and applying policies in this area. Given BC’s focus on primary health care transformation, these will be most beneficial in supporting change.

Finally, the study will provide a set of leading national practices for integrated health services delivery through PHC teams that will be helpful to all participating provinces, other provinces in Canada, and internationally.


End of Award Update: May 2022

Most exciting outputs

1. Primary Health Care (PHC) teams need to be integrated at the individual level (at the point of care to improve patient’s care), PHC teams also need to be integrated at the health system level to facilitate integrated health services delivery.

  • Clearly defined roles for team members are needed for effective PHC teams.
  • Strong support for co-located teams, but not always feasible given geography, and the increase in virtual care. More research is needed in comparing co-located and virtual teams, particularly in today’s context of increased virtual care delivery.
  • Interoperability and access to electronic health records, impacts team functioning. An accessible and shared electronic health record is needed for teams to function effectively.
  • Financial remuneration models continue to impact effective functioning of PHC teams.
  • Limited structure and information exist on performance measurement in PHC teams and integrated health services delivery. More work is needed at both the clinical and health system levels in performance measurement.

2. Ontario was more advanced in terms of engaging patients in policy activities, however, patients, family members, and caregivers who were engaged had similar experiences in policy engagement across the provinces. Patients were more often engaged in the development of policy, but engagement throughout the policy process (development, implementation, and evaluation) was much less clear.

3. Three key themes were identified: motivation for policy engagement, experiences with policy engagement, and barriers to engagement in policy, such as opportunities for engagement, power imbalances, tokenism, bureaucracy, accessibility, racism, sexism, and ageism.

4. Training in policy for patients, family members, and caregivers is needed to be better engaged throughout the policy process.

5. Opportunities for patients, family, and caregivers to engage in policy should be increased to facilitate inclusiveness and increase the diversity of perspectives.

Impacts so far

Our policy analysis on PHC teams and integrated health services delivery in four provinces in Canada, is to our knowledge the first of its kind. Our research results have been shared and we have discussed the same with the Primary Care, BC Ministry of Health. We have also shared the results of patient engagement in PHC policy with various stakeholders via the Putting Patients First Conference and the Canadian Association for Health Services and Policy Research Conference. Policy analysis results were also shared with international audiences through conferences and publications.

Potential future influence

Our research results have the potential to improve integrated health services delivery through PHC teams and to increase patient, family member, and caregiver engagement in PHC policy. The findings of the study can be utilized by other projects investigating what really makes PHC teams work, and which also include a policy analysis as well.

Next steps 

Knowledge translation: A virtual national knowledge translation event with patients, researchers, policymakers, decision-makers, and providers to share the results, as well as gather feedback on the findings. We will also share the results via plain language summary, infographics, and publications in academic journals.

Useful links

Video

Engaging Patients, Family Members, and Caregivers in Policy for Primary Health Care Teams Integration (Putting Patients First Conference, March 2022)

Cultural agility in Northern BC’s healthcare system: Increasing Indigenous employment participation and responsiveness to Indigenous well-being

Primary Investigator Dr. Sarah de Leeuw and Co-Investigator Dr. Margo Greenwood, together with northern and provincial partners, lead a five-year, 1.3 million research project focused on further enhancement of Indigenous health and the healthcare climate in northern BC.

"Cultural agility in Northern BC’s healthcare system: Increasing Indigenous employment participation and responsiveness to Indigenous well-being" aims to bring about a more culturally safe and humble health care environment in which to both provide and receive care, as well as inspire new generations of Indigenous professionals to join the healthcare systems of northern BC.

Funded through the Social Sciences and Humanities Research Council (SSHRC) and the Canadian Institutes of Health Research (CIHR), this is the first joint federal research partnership grant of its kind to be held at UNBC, and one of only nine such grants held across Canada. The work builds on a pilot project launched in 2016, with both projects part of the joint “Healthy and Productive Work Initiative”.

Central partners include Northern Health (NH), National Collaborating Centre for Indigenous Health (NCCAH), the Michael Smith Foundation for Health Research (MSFHR), Two Rivers Gallery, and the UNBC Office of Research. The project also includes and builds upon numerous new and existing Indigenous and non-Indigenous community partners and collaborators across the north. These include the First Nations Health Authority, the Northern Medical Program, UBC, McMaster University, the Rural Coordination Centre of BC, BC Cancer, Carrier Sekani Family Services, Central Interior Native Health Society, and the Prince George Nechako Aboriginal Employment and Training Association.

The partnership team coming together for this project leans heavily on a history of relationship, commitment, creativity and innovative problem-solving, and a continued need exists for strong relationships, individually, organizationally and systemically, within the shared goal to enhance culturally respectful and safe healthcare practice in northern BC.  

Targeting amyloid propagation in Alzheimer disease: Structures, immunology and extracellular vesicle topology

Dr. Neil Cashman is one of five BC researchers 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.

As the incidence of Alzheimer’s disease (AD) continues to increase worldwide, a treatment or prevention for AD is a top priority for medical science. One of the main hallmarks of the disease are protein plaques that form inside the brain, and are believed to be the primary cause of brain cell (neuron) death. Research has shown that the protein, amyloid-β (A-beta) is the main component of these plaques.

While there are many forms of A-beta produced by brain cells, the specific one that causes AD is hotly debated by scientists. Dr. Neil Cashman, a neuroscientist and neurologist at the University of British Columbia (UBC) has discovered a novel way of identifying a unique form of A-beta that can become toxic and inflict the damage associated with AD.

Cashman, who holds the UBC Canada Research Chair in Neurodegeneration and Protein Misfolding, and his team have discovered immunological compounds that specifically recognize the potentially toxic form of the A-beta protein, and can exclusively detect this form in the brains and spinal fluids of AD patients. Furthermore, Cashman found that normal, healthy control patients did not have this dangerous form of A-beta. It was also found that some healthy people naturally develop immune responses against their A-beta oligomer-specific target.

Cashman’s team will exploit this knowledge and their unique tools to learn how toxic A-beta proteins can spread from cell-to-cell and region-to-region in the brain causing AD. The discoveries by Cashman’s lab may provide an effective early diagnostic tool for the disease, and ultimately could lead to the development of a preventative vaccine to neutralize the toxicity of abnormal A-beta, potentially slowing or stopping the spread of neurodegeneration in the brain.

Propagated protein misfolding of SOD1 in ALS: Exemplar for neurodegeneration

MSFHR supported Dr. Neil Cashman’s award as one of two interprovincial teams from across Canada funded through Brain Canada’s Multi-Investigator Research Initiative (MIRI) in 2013. The MIRI supports the research of multidisciplinary teams and aims to accelerate novel and transformative research that will fundamentally change the understanding of nervous system function and dysfunction and its impact on health. MSFHR committed funding over three years to support the work of Cashman’s BC-based research activities and research led by fellow MIRI recipient Dr. Terrance Snutch on the role of brain calcium channels in brain disorders. Additional support was provided by Genome BC, the University of British Columbia (UBC)/Vancouver Coastal Health and two Quebec-based research institutes.

Amyotrophic lateral sclerosis (ALS), better known as Lou Gehrig’s disease, is a progressive fatal disease that affects the nerve cells responsible for muscle movement (motor neurons). ALS is characterized by the systematic paralysis of muscles due to the progressive death of motor neurons. An estimated 2,500 to 3,000 Canadians suffer from the disease, for which there is no cure or effective treatment. Each day, two to three people are lost to ALS, with 80 percent of affected individuals dying within two to five years of diagnosis. 

A study led by clinical neurologist and neuroscientist Dr. Neil Cashman at UBC has revealed how factors that cause ALS can be transmitted from cell to cell throughout the nervous system and suggests the spread of the disease could be blocked, pointing to new therapeutic approaches.

Neurodegenerative diseases like ALS belong to a larger group of illnesses known as protein misfolding diseases. Cashman, who holds the UBC Canada Research Chair in Neurodegeneration and Protein Misfolding, built on his hypothesis that certain proteins implicated in ALS, when abnormally shaped or misfolded, are prone to accumulate and cause motor neuron death. This disease mechanism has also been found in other neurological diseases, such as Alzheimer’s and Parkinson diseases. 

Cashman’s team used therapeutic antibodies that target and block these misfolded proteins to better understand the protein misfolding process and how the disease is transmitted throughout the nervous system. Cashman’s work can lead to identifying the best ways to stop the progressive neurological damage seen in ALS through the development of targeted treatments.

Integrating paramedics into primary care to optimize patient time in the community at end of life

MSFHR is providing matching funds to support Drs. Sabrina Wong and Jennifer Kryworuchko’s BC-based research as part of the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) Network in Primary and Integrated Health Care Innovation (PIHCI) initiative. The multi-province research team was funded through a SPOR PIHCI Provincial/Territorial Comparative Program and Policy Analysis Grant. MSFR is also supporting Dr. Kimberlyn McGrail’s PIHCI Comparative Program and Policy Analysis grant.

Many Canadians wish to spend their dying days at home. Despite this, 70 percent of deaths occur in hospital, the majority after a visit to the emergency department (ED). Paramedics, also known as emergency medical services (EMS), facilitate more than half of ED visits for patients receiving palliative care for a chronic condition.

One of the goals of British Columbia’s provincial palliative care strategies is to help enable people to stay at home as long as possible during their end of life. Currently, BC does not have a palliative care program within its Emergency Health Services (EHS).

Drs. Sabrina Wong and Jennifer Kryworuchko, faculty in the School of Nursing and Centre for Health Services and Policy Research at the University of British Columbia (UBC) are leading a team of researchers investigating innovative ways to deliver integrated emergency health services that support palliative care. The BC team collaborate with counterpart research team members in Nova Scotia who are examining the impact of the Nova Scotia EHS Special Patient Program on provincially funded health services and the ability to enable palliative patients to stay at home. Researchers will compare administrative health data from the two provinces on patients who received EHS paramedic services and died non-suddenly from chronic disease.

Since 2015, paramedics in Nova Scotia have received specialized clinical training on pain and symptom management and other care and support services for palliative patients as part of the Paramedics Providing Palliative Care at Home Project (PPPCHP). The PPPCHP is intended to enhance existing palliative care resources and the end-of-life experience for patients and their families/caregivers by bridging palliative care until their usual care team can take over. Researchers will identify the core elements of the PPPCHP essential for the program to be modified for rollout in BC.

In addition to improving end-of-life care and strengthening community-based care, the adoption of the Nova Scotia model in BC and other jurisdictions has the potential to reduce transport to the ED and avoid or reduce unwanted medical treatments, interventions and hospitalizations, contributing to reduced health care system costs.

Validation of administrative and primary care electronic medical record derived frailty algorithms

MSFHR provided funding to support Wong’s research as part of the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) Network in Primary and Integrated Health Care Innovation (PIHCI) initiative Quick Strikes program. Quick Strike research projects support rapid turn-around, time sensitive, cross-jurisdictional research studies that align with the pan-Canadian Networks Quick Strike research priorities which are intended to show the potential of the Network to address questions of relevance to multiple provinces and territories in a one-year timeframe.

Frailty is a significant and growing issue in Canada. By 2025, two million Canadians will be living with frailty and 3.75 million Canadians will be caregivers. Characterized by reduced strength, endurance and physiological function, those who are frail or at risk of becoming increasingly frail are less resilient to recover from significant life events and respond to acute care treatments, and are vulnerable to further decline, dependence and death.

Dr. Sabrina Wong of the University of British Columbia’s School of Nursing and Centre for Health Services and Policy Research worked with Dr. Tyler Williamson from the University of Calgary and Dr. Alan Katz from the University of Manitoba on the development of tools to aid in the early detection and accurate identification of frailty in seniors, to supporting healthy aging and the needs of older adults.

Using data from seniors 65 years of age and older in British Columbia, Alberta, and Manitoba, they developed an algorithm for use with administrative health data and another for use with electronic medical record data. Researchers also engaged primary care clinicians and patients in developing ways to identify frailty and to detect the range of frailty in patients to be used as part of the algorithms.

Finally, they sought to implement the electronic medical record algorithm in the Canadian Primary Care Sentinel Surveillance Network’s (CPCSSN) web-based reporting tool, InQUIRE (Interactive Quality Improvement Reporting Environment) to provide timely feedback on frailty back to primary care clinicians.

The results of Wong’s study will provide new knowledge that could inform both clinical care and jurisdictional level health services planning across Canada in order to improve patient care, patients' and caregivers' quality of life and better use of the healthcare system.