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Transitions and trajectories in late life care: Patterns and predictors

The primary purpose of this study is to examine the main transitions that older adults experience as clients of home care, assisted living, and long-term residential care. In collaboration with health care decision-makers from the Fraser Health Authority and the province of British Columbia, two research questions will be addressed:

  1. What are the most common pathways by which older adults transition through the long-term care system (e.g., home care, assisted living, residential care)?
  2. How do individual factors (social, psychosocial, health) influence these transitions?

A better understanding of the patterns that emerge and the factors that influence care transitions is critical for enhancing the quality of life of older adults and their families and for developing policy and program recommendations for health system improvements.

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A mixed method evaluation of the impact of the Dr. Peter Centre on health care access and outcomes for persons living with HIV/AIDS who use illicit drugs

Persons living with HIV/AIDS (PHA) who use illicit drugs often experience poorer health outcomes than those who do not. The Dr. Peter Centre (DPC) is a community-based HIV/AIDS health care centre located in Vancouver, British Columbia (BC) that is run by the Dr. Peter AIDS Foundation. As a strategy to address this problem, the DPC offers a combination of services to vulnerable PHA, many of whom use drugs. These services include harm reduction services (including supervised injection services), social programs, counselling services, meals, housing referrals, and referrals to mental health resources.

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Health services researcher pathway

A project team led by Dr. Noreen Frisch, co-leader of InspireNet and director of the University of Victoria’s School of Nursing, will develop a pathway that will clearly describe the knowledge, skills, and attitudes nurses hold at various stages of their careers that contribute to a culture of research that impacts quality of care.

As a career trajectory for nurses, the pathway will guide progress through research levels, from finding, interpreting, and applying health services research evidence in their work, to working with established researchers, to pursuing a career as a health services researcher.

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Transforming spaces, transforming lives: An integrated community partnership to enhance the health and mobility of older adults

This project is a unique opportunity to capitalize on a “natural experiment” that will allow for understanding of the community impact of healthy, social, mobility-focused urban design on older adults; an aging demographic that will challenge cities to adapt the urban environment to be “age-friendly”, to allow for people to live healthfully, comfortably and independently as they age.

In partnership with the City of Vancouver, the researchers will evaluate the process of creating and implementing community-informed built-environment changes that put walking and cycling first (mobility) and that highlight the role of place-making (social spaces that build a sense of community) and their impact on mobility and health outcomes of older adults.

With a strong commitment to knowledge translation and moving research into action, solutions will be found on how best to implement built-environment modifications to enhance the mobility of older adults and slow the course of mobility decline and social isolation faced by older adults. Project results will be shared through the generation of a guideline document for cities that wish to make ‘age-friendly’ built-environment changes.

Principal Investigator:

  • Dr. Heather McKay, Professor & Director of the Centre for Hip Health & Mobility, Department of Orthopaedics and Family Practice, University of British Columbia

Community Partner:

  • Dale Bracewell, Manager, Active Transportation, Department of Engineering Services, City of Vancouver

KidsCan: Involving youth in research to create mHealth solutions for improved youth health

Through the establishment of a youth engagement initiative (KidsCan) this project will directly involve Canadian youth as advisors and partners in the research and development of innovative mobile based solutions to health problems that face today’s youth. The researchers and community partner will address the problem of childhood obesity that threatens the well being of Canadian youth and society. With direct involvement of youth partners in the design and evaluation processes, a smartphone application (MobileKids) will be developed that will help promote voluntary physical activity and healthy eating habits among youth. Along with interesting activities that require physical effort, the MobileKids application will include readily available nutritional information and interesting physiological data like heart and respiratory rates that can be used to generate peer support and interpersonal competition among young users to develop and adhere to healthy habits. In the long term, the KidsCan initiative will serve as a platform for development of more innovative solutions like MobileKids, while getting youth excited about science and research.

Principal Investigator:

  • Dr. Guy Dumont, Professor, Faculty of Applied Sciences, Department of Electrical and Computer Engineering, University of British Columbia

Community Partner:

  • Dr. Jean-Pierre Chanoine, Sub-speciality Director (Research Component), Centre for Healthy Weights Program, ShapeDown BC

Co-Investigators:

  • Dr. John Mark Ansermino, Associate Professor, Medicine, Department of Anesthesiology, Pharmacology and Toxicology, University of British Columbia
  • Dr. Anne Junker, Associate Professor, Medicine, Department of Pediatrics, University of British Columbia

MSFHR/CIHR Science Policy Fellowship

The MSFHR/CIHR Science Policy Fellowship aims to bridge the gap between the worlds of science and policy by funding Noreen Kamal to be embedded for six months in the British Columbia Ministry of Health. In this position, Kamal will be tasked with developing evidence-based provincial policy and funding options for emergency department services in BC.

Despite a wide range of provincial initiatives to increase quality and efficiency in emergency departments throughout the province, there are still a number of outstanding issues relating to emergency department services. The BC Ministry of Health is currently undertaking a cross-divisional operational review of emergency care, with phase one ccompleted in March 2012.

The first phase will be focused on qualitatively and quantitatively describing services in BC using a variety of information sources. Kamal will co-lead the second phase of work that focuses on analyzing current services in the context of evidence-based best practices in service configuration and funding and proposing options appropriate for BC.

The program was designed with the goal of establishing and nurturing critical links between policy-makers and external researchers in support of evidence-based public policy.

Transforming community-based primary health care delivery through comprehensive performance measurement and reporting

This award is co-funded by Health Research BC, through CIHR’s Community-Based Primary Health Care (CBPHC) Innovation Teams Grant. 

 

Most Canadians enter the health care system through a visit to a doctor, nurse practitioner or healthcare team based in their communities for the treatment and management of a wide variety of acute and chronic health problems. CBPHC covers a range of services across the continuum of care: primary prevention (including public health) and primary care services; health promotion and disease prevention; chronic disease diagnosis, treatment and management; rehabilitation support; home care and end-of-life care.

 

Although Canada is spending an increasing share of its revenue on healthcare, it is falling behind other industrialized nations in obtaining value for its investment. While Canada has made substantial financial investments in renewing CBPHC over the last decade, no information system exists to routinely capture whether renewal efforts improve CBPHC performance or quality of care in Canada.

 

Dr. Sabrina Wong, a professor in the School of Nursing and Centre for Health Services and Policy Research at the University of British Columbia (UBC) co-led a multi-provincial research program to improve the science and reporting of performance measurement of the primary health care system in Canada.

 

Working with co-PIs, Drs. William Hogg and Sharon Johnston of the Bruyère Institute in Ottawa and Fred Burge at Dalhousie University, the team conducted four studies over the five-year research program using data collected and analyzed from three study regions in British Columbia, Ontario and Nova Scotia with similar socio-demographic characteristics. The aim of their work was to learn how comprehensive performance measurement and reporting could support improvements and innovation in the delivery of primary care services to Canadians, especially populations vulnerable by multiple poor determinants of health.

 

By measuring and reporting on how regions within the health system performs, Wong’s research — the first of its kind in British Columbia and Nova Scotia — provides a foundation to transform the organization and delivery of the Canadian CBPHC system, leading to an enhanced patient experience, improved health outcomes and reduced costs.

End of Award Update – February 2022

Most exciting outputs

The TRANSFORMATION study set out to improve the science of performance measurement in primary health care in Canada. As the project comes to a close, it has demonstrated success in identifying performance measures of significance to patients, clinicians, and policy makers; advancing methods for the collection of patient reported experience and outcome measures; developing health segmentation methods and inter-provincially comparable indicators of primary care performance using health administrative data. Findings have been shared through conference presentations, journal publications, and engagement of policy makers and health region administrators.

 

Impact so far

The study has advanced the use of mixed methods in this area of research. Knowledge translation and the training of graduate and post-graduate students in primary health care research methods has resulted in spin-off projects. The Public Health Agency of Canada has recently funded a project to address vaccine hesitancy through primary care practices using a patient outreach and survey system piloted as part of the Transformation project. In Nova Scotia, the study has informed development of annual surveys of patient health experience required for institutional accreditation.

 

In BC, work completed by TRANSFORMATION on the patient reported experiences and outcomes survey was used to inform the office of Patient Centred Measurement in their work on development of a population-based primary care experiences survey (originally slated to roll out in 2021). This work was also used by Doctors of BC in their development and implementation of a practice-based patient experiences survey. Work completed on using administrative data to formulate population segments informed the work of the BC Ministry of Health in how different segments of the population use primary care services. The work of TRANSFORMATION has also been used by scholars and research students, providing opportunities to publish, present results, and connect with other leading primary health care researchers across Canada.

 

Potential future influence

Learnings from this project are being used to inform development of the patient reported indicator surveys for the Organisation for Economic Co-operation and Development. Knowledge, methods, partnerships and software developed through this project is already increasing the capacity for performance measurement, including by developing supporting infrastructure for a primary care learning health system in Canada.

 

Next steps

Our next stage of work is moving the science, theory, and discoveries from this work, into practice. This work is in progress, including the further development of automated systems to collect data from patients in a timely manner and provide practices with data for near real time QI efforts. In addition, there is interest in integrating data from electronic medical records to support quality improvement and performance measurement in primary health care. Future work will be needed to refine methods for using these measures to influence behaviour – both at the level of primary care patients and practices and at the health policy level.

 

Useful Links

HIV adaptation to immune selection pressures: historic trends and future implications

HIV has tremendous capacity to mutate and evolve due to the body’s immune response. However, the extent to which the virus has adapted to its human hosts over the course of the pandemic remains poorly understood. Repeated cycles of immune selection and transmission may allow the accumulation of key “escape mutations” — changes in the viral genome that help HIV evade the body’s defences. If immune targets in the HIV genome were disappearing over time due to the accumulation of these mutations, our ability to generate natural and vaccine-induced protective immune responses would diminish as the epidemic progresses.

Furthermore, the extent to which immune escape has influenced HIV pathogenesis remains unknown. Studies investigating the evolution of HIV virulence have largely focused on population-level trends in clinical markers over time, but few have addressed this issue using biological assessments of replication capacity or viral protein function.

Dr. Zabrina Brumme’s research team will undertake the first large-scale investigation of immune-driven HIV evolution and its implications over the 30-year history of the epidemic in North America. Host and viral genetic sequences from 1979 to the present will be analyzed to characterize the extent of population-level HIV adaptation over the epidemic’s course. Functional assessments of viral replication capacity and protein function will be performed to determine whether HIV is evolving towards increased virulence, gradual attenuation, or simply adapting to changing host-pathogen pressures over time.

With this study, Brumme is poised to answer two key questions of HIV biomedical research, namely, to what extent the virus has adapted to its hosts since AIDS was first recognized, and what implications this has for the future of the epidemic. Results have the potential to significantly advance HIV vaccine research.

Characterization of the formation of protein aggregates induced by the inhibition of the ubiquitin proteasome system

Protein aggregation is a pathological feature of a large number of diseases with a strong preponderance in age-related neurodegenerative disorders like Parkinson’s disease. Failure to eliminate aberrant proteins in the cell plays a major role in these pathologies and is often linked to the impairment of the ubiquitin proteasome system, which degrades proteins labeled (or modified) with ubiquitin. The overall goal of Dr. Thibault Mayor’s research is to further define the involvement of the ubiquitin proteasome system in aggregation diseases using proteomic and cell biology approaches.

Mayor’s team has developed a new cellular assay to monitor the formation of aggregates induced by proteasome inhibition. They have identified by mass spectrometry more than 500 proteins that localize in these structures. Using a computational approach, Mayor will determine which features are shared among these proteins to give better insight into the mechanisms leading to aggregation. The UCHL1 enzyme may also be a major player in the aggregation process, and Mayor’s team will use the cell assay and mass spectrometry to further characterize UCHL1 and determine whether other enzymes related to the ubiquitin proteasome system may promote aggregation.

Current treatments for most aggregation diseases are primarily based on symptom management instead of directly treating the cause. Mayor’s work may potentially lead to a better understanding of the aggregation mechanism and identify novel targetable pathways to prevent formation or favor clearance of protein aggregates that could be used for new therapeutics.

A wearable assistive device for improving quality of life

Mobility of the upper extremities has a significant impact on independence and quality of life. For individuals with neuromuscular disorders due to aging, stroke, injury, or other diseases, the activities of daily living (such as eating and dressing) can be very challenging. However, biomedical robotic technologies offer a promising tool with which to improve the mobility of individuals with impaired upper extremities.

Collaborating with experts in the field of neuromuscular rehabilitation, Dr. Carlo Menon is leading the design and development of a smart assistive medical device that is portable and wearable. The objective is to develop a device that will assist with functional movements and strengthen muscular tone of the weakened or impaired extremities. The device will have potential use for both upper extremity assistance and rehabilitation.

This research will improve the quality of life for individuals with neuromuscular disorders by restoring mobility of the upper extremities. The proposed project will include the following phases: a) interaction with the neuromuscular collaborators to iteratively reformulate the design; b) the engineering design and development of the biomedical robotic device; c) the engineering testing of the device; d) a study of the interactions between the device and both healthy volunteers and individuals with neuromuscular disorders to verify that the device can assist functional movements; e) technology transfer to neuromuscular scientists and clinicians.