Supporting a Learning Health System in British Columbia Through Developing the BC Academic Health Science Network (AHSN)

In partnership with the BC Academic Health Science Network and the UBC Centre for Health Services and Policy Research (CHSPR) Singal will support the strategic and operational development of the BC AHSN.

Priority 1 is to develop and execute a regional level initiative that contributes to the provincial priority of enhancing primary health care delivery in BC and contributing to the development of a robust data platform. 

Priority 2 is to use that specific initiative to identify and resolve systemic issues necessary to ensure initiative success, and to guide development of the AHSN overall to support a learning health system in British Columbia.

Economic evaluation and cost valuation of a province-wide quality improvement initiative: a case study of ‘Call for Less Antipsychotics in Residential Care’ (CLeAR) in British Columbia

British Columbia has 62,000 people living with dementia and this number is expected to rise to 87,000 by 2024. A common challenge for many seniors is the behavioural and psychological symptoms of dementia. In October 2013, the British Columbia Patient Safety & Quality Council (BCPSQC) launched its initial cohort of care homes participating in a 'Call for Less Antipsychotics in Residential Care' (CLeAR) quality improvement (QI) initiative in response to rising concerns over inappropriate antipsychotic use in residential care. 

This study will include a comprehensive economic evaluation and cost valuation of a province-wide QI initiative. A mixed-methods approach to economic evaluation will be embedded into the third cohort of CLeAR. Data collection and analysis will take place in three phases, starting with literature review of available economic studies on quality improvement and related patients outcomes; approximately 30 qualitative interviews with care home residents to explore their perspective in the design and execution of CLeAR; secondary data analysis to determine costs and patient-level clinical outcomes, and finally cost-effectiveness analysis to estimate cost per life year gained. 

The findings will inform stakeholders and the Ministry of Health about decisions on resource allocation for interventions designed to address both technical and non-technical (e.g. culture, teamwork) aspects to improve quality of care.

Measuring the impact of current and future harm reduction strategies in the ongoing opioid overdose epidemic in British Columbia

North America is currently experiencing an opioid overdose crisis and this has been particularly pronounced in British Columbia (BC). In this jurisdiction there has been a rapid increase in overdose deaths since 2012, which has largely been driven by an increasing concentration of synthetic and more potent opioids in the illegal drug supply market. 

Despite a large effort within the province to reduce opioid-related harm, overdose deaths have continued to rise. Efforts include a scaling-up of BC's Take Home Naloxone program, a non-clinician administered therapy that is highly effective at reducing the effects of an overdose. More novel interventions have also included the introduction of opioid overdose sites, where people who use drugs can be observed and helped if they overdose. There is therefore a greatly urgent and important need to estimate the impact of these interventions and where new resources would be best positioned to have the most impact. 

In collaboration with the BC Ministry of Mental Health and Addictions and with support from BC Centre for Disease Control and the Ministry of Health, Irvine will estimate the impact of the current interventions to date as well as project the impact of future interventions and scale-up. Combining cutting-edge mathematical modelling and statistical techniques with provincial administrative datasets will support an evaluation of the current provincial interventions and estimate the number of deaths averted due to current intervention scale-up and proposed novel interventions. The collaboration with both Ministries will ensure modelled scenarios will reflect policy proposals and help to support and inform their decisions.

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.

Patient/Public Engagement Measurement and Evaluation Project (PEMEP) within the British Columbia Ministry of Health’s Patients as Partners Initiative

In 2010, the Patients as Partners Initiative of the British Columbia (BC) Ministry of Health began work to improve the BC healthcare system by partnering with patients to empower patients and to develop and support the implementation of sustainable healthcare policies. This quality improvement initiative provides leadership, strategy, policy, collaboration, and funding to bring patient voice, choice, and representation to the forefront of the health sector. 

This initiative's spectrum of patient engagement activities is performed across many projects using the International Association of Public Participation (IAP2) approach of inform, consult, involve, collaborate and empower at the individual, community, and health system levels. A small but growing number of publications cover the principles, measurement, and evaluation of patient engagement in various aspects of the healthcare system.  But to date, no measures or quality indicators have been validated to assess the outcome and impact of patient engagement activities. Further research is vital to providing evidence-informed tools to quantitatively evaluate both the impact of integrating the patient/public perspective into planning, policy and services of BC's healthcare system and the impact that engagement is having on health outcomes. 

The overall aim of this project is to identify, validate, and implement quality indicators of patient engagement at the individual, community, and system level within the Patients as Partners Initiative by the BC Ministry of Health. This will be conducted in a three-phase study: 1) a scoping review will identify key quality indicators from the published and grey literature; 2) a Delphi study with a 20-member panel of key stakeholders will validate the identified indicators; and 3) a stakeholder consultation workshop will facilitate creation of a plan to pilot test and routinely collect the quality indicator to measure and evaluate the success of patient engagement.

Utilizing a syndemic approach for population level prevention, care and treatment cascades of hepatitis C virus and related epidemics

Different distributions of social conditions, vulnerabilities, (e.g. drug use, mental illness) or other infections (HIV, HBV, TB), contribute to differences among populations affected by hepatitis C virus (HCV) infection. The different distribution of these comorbidities drives differences in cascades of care (diagnosis, initiation of treatment, cure and retention in care). 

This study aims to improve HCV treatment and prevention by applying concepts of syndemic theory (how co-occuring conditions interact) to improve the integration and delivery of health services among populations affected by HCV infection, such as people born 1945-65 ("Baby Boomers") and people who inject drugs (PWID). Using the British Columbia Hepatitis Testers Cohort (BC-HTC), which includes all individuals tested for HCV, HIV, HBV, sexually transmitted infections or TB since 1990, linked with administrative and healthcare data, the study will extend the HCV cascade of care to include prevention and care related to underlying syndemic factors (e.g. drug use, mental illness and other co-infections). 

Identifying and investigating gaps in HCV care cascades, and syndemic factors associated with these gaps, will help identify avenues for shared and integrated interventions to improve prevention and care for HCV, and underlying substance use.

Knowledge dissemination efforts of peer engagement research: Reframing the language of the opioid crisis

Co-leads:

  • Jane Buxton
    University of British Columbia
  • Travis Lupick
    Georgia Straight

Trainee:

  • Lindsay Shaw
    University of Victoria

The media can greatly influence how the public perceives people who use drugs (PWUDs). With the escalating opioid epidemic in British Columbia, reframing how one thinks about and describes PWUDs is key to reducing the stigma of drug use, and the subsequent reluctance of PWUDs in accessing health services. While stigma surrounding drug use has traditionally served as a deterrent, it is becoming increasingly recognized that the stigmatization, discrimination and isolation of PWUDs has led to poorer health outcomes and further marginalization. Hence, a need to address the language surrounding substance use disorders and drug addiction and those who use drugs has emerged.

Co-developing with local and regional journalists in BC (knowledge users), Dr. Jane Buxton (research co-lead; BC Centre for Disease Control and University of British Columbia) and her team will attempt to translate innovative peer engagement research to optimize uptake by journalists, and reframe the language used to describe PWUDs. Peer engagement can be defined as the active participation of people with lived experience of substance use in research and policy decision-making processes. Key elements and potential outcomes of knowledge transfer activities include:

  • Organization of a knowledge symposia with local and regional knowledge users (i.e. key media) to share, contextualize and harmonize the research with existing practice norms.
  • Development of a news release and media availability with a peer spokesperson, researchers, and research users (based on synthesized knowledge from the symposia).
  • Creation of a one-page infographic document for BC newsrooms.
  • Creation of original photography that accurately shows different views of the opioid crisis, which would then be provided to the media as stock images.
  • Submission of an editorial on behalf of the research team that contextualizes the role language plays in reducing stigma among people who use drugs.
  • Creation of a brief educational module offered to BC’s five schools/departments of journalism to share the synthesized findings among journalism and broadcast trainees.
  • Outreach campaign to editors of The Canadian Press Stylebook (popular reference book providing guidelines to journalists; published annually).

Autism and Aboriginal families: Bridging the cultural gap through collaborative dialogue

Research co-leads:

Research user co-leads:

  • Romona Baxter
    Nzen’man’ Child and Family Development Centre Society

Team members:

  • Emily Gardiner
    University of British Columbia
  • Deborah Pugh
    Autisum Community Training
  • Rona Sterling-Collins
    Rona Sterling Consulting

This project will shine a light on a particular health inequity facing Aboriginal* communities in British Columbia, specifically those related to the delayed access to diagnostic and treatment services for individuals with autism spectrum disorder (ASD).

Though precise prevalence rates of ASD among Aboriginal children in Canada are unknown, data from other populations indicate this disorder is significantly under-diagnosed among Aboriginal populations (e.g. Native Americans and Australian Aboriginals). Recent personal communication with the provincial ministry overseeing ASD diagnosis and intervention funding (Ministry of Children and Family Development) suggests that in British Columbia, ASD is as prevalent among Aboriginal children as it is among those of non-Aboriginal ancestry, but that these children are receiving a diagnosis later and missing out on critical early intervention. We suspect this difference in access is related to unique challenges associated with geographical and cultural issues, the lack of specialized professionals in rural and remote regions of the province, cultural and spiritual beliefs about disability, and to histories of colonization and oppression.

This project aims to address this health disparity by beginning a dialogue with Aboriginal communities about their experience with ASD.

A two-day knowledge gathering event for Aboriginal families of children with ASD and their service providers will be hosted in partnership with an Aboriginal community. At the event, an overview of available provincial resources will be provided, including culturally appropriate information on ASD. Attendees will then be broken into small breakout discussion groups, and families and service providers will be invited to share their support experiences, perceived gaps and needs, and identify opportunities for how health research could facilitate improvement. Information and resources will be shared and exchanged with families, professionals, and community leaders.

These events will allow for the gathering of information on the challenges and barriers experienced by the Aboriginal communities of the Nlaka’pamux Nation, comprised of 16 First Nation communities in the Lytton and Merritt areas, as well as an off-reserve population in the Merritt area. Once the support needs of this community is understood, priority policy issues and future research questions will be identified.

* ‘Aboriginal’ is the term of preference for our research user co-lead.

Collaborative development of a dynamic electronic frailty index (eFI) for older adults living with frailty

Research co-leads:

  • Xiaowei Song
    Fraser Health

Research user co-lead:

  • Rowena Rizzotti
    Health and Technology District, Lark Group

Team members:

  • Ryan D'Arcy
    Simon Fraser University
  • Bimal Lakhani
    HealthTech Connex Inc
  • Carlo Menon
    Simon Fraser University
  • Chelsea Stunden
    Lark Group

The Canadian population over the age of 65 is expected to increase to 15 million by 2061, with 23% showing indicators of frailty. There is growing evidence that frailty is related to cognitive and physical decline; however, frailty assessments are not yet utilized effectively in community and residential settings to prevent adverse health events.

Rapid advancements in frailty assessment have demonstrated that deficits accumulation can predict health and function over time, and when used properly, can predict the need for institutionalization. The goal of this research is to enhance multi-disciplinary partnerships and stakeholder collaboration to create evidence. This will inform a knowledge translation plan for developing a dynamic electronic frailty index that can monitor frailty indicators within the community environment, continuously and dynamically.

Over the 12-month funding cycle, we will convene and collaborate with multi-disciplinary (researchers, research users, caregivers, seniors) stakeholders over five co-designed engagement activities, informed by ecological principles. The workshops will:

  • Identify the resources available to monitor frailty progression.
  • Identify the people, systems, and structures available and ready to monitor deficits accumulation.
  • Use the data collected to create an evidence-based knowledge translation plan that can inform decision making for developing a dynamic electronic frailty index that continuously and dynamically monitors frailty in the community setting.

Qualitative data will be thematically coded and analyzed. Knowledge translation and dissemination strategies will follow the Ageing Framework by the World Health Organization to ensure best-practices.

Building a new partnership between First Nations Health Authority and the University of British Columbia for community-based research to improve Indigenous women’s heart health

Research co-leads:

Research user co-lead:

  • Jeffrey Reading
    First Nations Health Authority

Team members:

  • Alexandra Kent
    Simon Fraser University
  • Krista Stelkia
    Simon Fraser University

This team will build a new partnership to collaboratively develop, and pursue funding for, a community-based participatory feasibility study on a novel arts-based approach to address Indigenous women’s heart health. The aim is to fill the knowledge gap in heart health research and policy in Canada by explicitly focusing on Indigenous women as a unique and vulnerable group. A holistic perspective will be employed on heart health disparities of Indigenous women and a participatory-based action research approach will be taken to communicating heart health risk that is culturally safe and respectful.

To develop and foster new and meaningful relationships between researchers and researcher users for future research collaboration, inter-related activities for this relationship-building work includes:

  1. An initial meeting in Vancouver for partners to learn more about each other, discuss equitable collaborative principles and operating norms, and explore community interest in an arts-based prevention program for women’s heart health.
  2. Two additional partner meetings by telephone to collaboratively develop research questions and plans that will support a grant application.
  3. Three on-site visits to remote Indigenous communities selected and invited by the First Nations Health Authority for potential research interest, to learn about and discuss local Indigenous women’s heart health priorities, and assess personal and community capabilities and resources for a future feasibility study on an arts-based community approach to heart health promotion.
  4. Regular communication in between meetings to support organizing and follow-up activities.
  5. Review literature to prepare background materials for meetings and a future study protocol.
  6. Draft a collaborative feasibility study protocol to pursue research funding.

This will result in:

  1. Producing new foundational knowledge about the unique set of risk factors and determinants of heart health among Indigenous women in BC.
  2. Creating authentic relationships between new partners that will establish the foundation upon which future research collaboration can be built and successfully implemented.
  3. Building the KT capacity of two doctoral students as research trainees on this project, who will be given multiple opportunities to improve soft and hard skills relevant to research on Indigenous health.

Together, these outputs will help this new partnership achieve the primary outcome of increased collaboration and research proposal submissions to pursue the novel research agenda.