Health Services

Over 80% of patients who are treated in the intensive care unit (ICU) for a life-threatening illness face reduced physical health, emotional wellbeing and quality of life. Up to half of patients discharged from the ICU are readmitted to hospital within a year with complex medical conditions. This is a tremendous cost of cure for survivors and their family caregivers. Services for patients with complex medical conditions and/or frail patients is a BC Health System Priority.

My career goal is to improve the health and quality of life of older Canadians through applying innovative health economic methods to lifestyle interventions among older adults at risk of falls as well as cognitive and functional decline. I propose a multi-disciplinary research program that advances health economic methods for clinical research studies.

Theme 1 of my research program will advance health economic evaluation methodology by answering the question: “Can artificial intelligence combat current methods limitations of economic evaluation?”

Our goal is to use smartphones and artificial intelligence to improve pain management for children having surgery. This is needed because many children still have a lot of pain even a year after surgery. The pain affects their daily life, and might cause them to return to hospital. A child’s pain is affected by many things, like their biological sex, anxiety, coping skills, pain level, and type of surgery. Importantly, some of these can be altered.

We will collect data to identify patterns that predict which children

Maps are an excellent way of simply communicating complex ideas. We will create maps that use sophisticated analysis techniques and draw on multiple information sources. Our maps will tell decision-makers where in BC they should focus COVID-19 mitigation efforts and other interventions.

Women who inherit a BRCA gene mutation are at high risk for breast cancer and the most lethal type of ovarian cancer, high-grade serous ovarian carcinoma (HGSC).

A woman diagnosed with HGSC has a 20% chance of unknowingly carrying a BRCA mutation, and is eligible for genetic testing. Getting a blood sample to do genetic testing in this woman is critical, because if she is found to have a BRCA mutation: 1) her relatives (daughters, sisters) can be tested, and HGSC can be PREVENTED in them, and 2) she herself can be treated with PARP inhibitors that can improve survival.

Out-of-hospital-cardiac arrest (OHCA) affects 40,000 Canadians per year. Cardiac arrest is the sudden loss of heart beating, and can occur in people with or without known heart disease. In British Columbia (BC), only 15% of these patients live (50% die before hospital, 35% die in hospital), less than 50% receive bystander cardiopulmonary resuscitation, and only 3% receive bystander automatic external defibrillation. Due to a lack of connected data, little is known about the effect of treatments on long term survival, brain function and quality of life after leaving hospital.

Indigenous peoples in Canada suffer from significantly higher rates of diabetes and obesity, resulting in reduced quality of life. There is often a lack of Traditional knowledge and community leadership within health, government, and community organizations. The impact of Western care services on improving health are often limited, whereas inclusion of Indigenous community-led care services has shown to improve health. Our current study will co-develop, co-implement, and co-evaluate locally-informed, culturally relevant diabetes and obesity programs in six urban/rural Indigenous Centres.

The emergence of novel technologies in health care is associated with promising opportunities to improve patient health outcomes. Advances in health technologies also come at a substantial cost. New gene therapies have been estimated to cost between $300,000-$4,000,000 per patient. These new therapies offer promise, but do not offer certainty; decision-makers have to choose whether to reimburse the therapy with little evidence for how it might work in the real-world.

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

The drug overdose crisis has been hardest felt in BC. Research has shown that gender plays a key role in shaping contexts of drug use (e.g., within sex work, intimate partnerships) and access to treatment and harm reduction services. Women access treatment with more severe drug-related profiles relative to men (e.g. violence/trauma), yet few services are women-centred. New Vancouver Coastal Health guidelines highlight grave gaps in supports and prevention for marginalized women, and several new models of care are being rolled out (e.g., women-only consumption rooms).

This study will examine how organizations are able to roll-out and improve GetCheckedOnline (GCO), an internet-based testing service for sexually and blood transmitted infections currently available in British Columbia.

Using the research approach of institutional ethnography, this study aims:

Decision makers need to decide how to best allocate limited societal and healthcare resources to fund different healthcare services. Health economic evaluation is a tool commonly used to inform these types of funding decisions; however, which costs to consider in economic evaluation can have a significant impact on the resulting funding decision. A societal perspective considers costs within the formal healthcare sector (e.g., physician, hospital and drug costs) as well as costs outside the healthcare sector (e.g., work productivity costs of patients and their family caregivers).

Endometrial cancer (EC), or cancer of the uterus, is the most common gynecological cancer in Canada, with new cases and deaths increasing annually, due to an increase in the rate of common risk factors, like obesity. In British Columbia, the number of new EC cases is projected to increase by 50% and mortality to double by 2031. We must investigate economically feasible prevention strategies to control the rate of this cancer.

Depression has recently become the leading cause of disability, worldwide. It affects one out of every 20 Canadians, causing significant suffering to patients and their families and costing the economy CAD$32.3 billion each year. Previous efforts to address the burden of disease caused by depression have mostly been focused on expanding access to mental health services.

The healthcare system is undergoing a paradigm shift toward person- and family-centred care. While this is a critical priority, it will be challenging to put into practice. One strategy to implement this change is shared decision-making (SDM), a process that supports patients and providers to discuss the risks and benefits of options, clarify preferences, and make choices based on their informed values. Knowledge translation and implementation science (KT/IS) are key approaches for accelerating this system change.