Advancing Equitable Cancer Care for Incarcerated Populations

An estimated 40,000 individuals are imprisoned in Canadian correctional facilities at any time. Incarcerated people, often individuals from marginalized populations, bear an unequal burden of cancer because they experience chronic disabilities, mental health concerns and substance use disorders. Increased risk factors also include family violence, childhood abuse, housing insecurity, lack of education, low-income status, high rates of suicide, high-risk sexual behaviors, and physical injuries. Despite international recognition of the importance of palliative and cancer care as a shared universal right, a health equity gap exists between the general and carceral populations in Canada. Incarcerated people face significant health inequities before, during and post incarceration. 

This project aims to address BC Cancer’s goal of promoting high-quality cancer services that are    equitable, accessible, and respectful for all British Columbians. 

The specific objective is to provide evidence-based recommendations for advancing equitable cancer care for incarcerated populations in BC by examining barriers in access to cancer treatment and care.  

Modelling the Future of Home Health for Seniors – A Markov based Cost Effectiveness Analysis

The task of providing high quality care has become increasingly difficult as pressure mounts on both the funding and demand side of the provision equation. This challenge is particularly acute for health leaders caring for a growing elderly population in an already strained system. While our senior patient populations consume more expensive acute healthcare resources with higher frequency, they are also more likely to experience negative outcomes in these venues of care and often prefer to remain in their homes for as long as possible.   

The Economic Learning Health System (eLHS) is a framework designed to guide continuous improvement and optimization of limited health care resources to achieve the highest possible quality of care for patients. This research project is aimed at applying this framework to the challenge of caring for seniors in British Columbia. Anticipated outcomes include an analytic infrastructure that will quantify care needs, simulate potential innovations to address these needs, and determine the most sustainable path to caring for our seniors now and in the future. 

This project was funded by the Health System Impact Fellowship from CIHR, and is being conducted in partnership with the BC Ministry of Health. The fellow leading this project is Dr. William Hall – a health economist trained at UBC and creator of the eLHS framework. He will be working with Dr. Michael Law from the Centre for Health Services and Policy Research, and Christine Voggenreiter from the BC Ministry of Health.

Implementation of a clinical population screening program for BRCA1/2 mutations among individuals of Ashkenazi Jewish ancestry

This Health Systems Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and BC Cancer (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making. 

Approximately 1 in 40 individuals with Ashkenazi Jewish ancestry are born with a mutation in the BRCA1 or BRCA2 gene, in comparison to 1 in 200 in the general population. These individuals are at a high risk to develop multiple cancers over their lifetime, including breast and ovarian cancer for females. Genetic testing can help to determine whether an individual has a BRCA1/2 mutation. Once identified to have a mutation, patients can become eligible for more cancer screening (e.g. yearly breast mammograms and MRIs for females) and have the option to undergo surgery to reduce their risk (e.g. removal of ovaries). These can reduce the risk of cancer or help to detect it early. Current programs to identify individuals with BRCA1/2 mutations are not effective; less than 50% of these individuals are identified. To address this gap in cancer care, Dr. Intan Schrader, Dr. Sophie Sun and their team at the Hereditary Cancer program at BC Cancer have designed a pilot population screening program, which will allow anyone of Ashkenazi Jewish ancestry to obtain testing for BRCA1/2 gene mutations. The proposed project will also involve design and implementation of a public education campaign and adaption of a patient-facing digital tool that will guide patients through the population screening program. Altogether we hope this project generates evidence to support the implementation of a population-wide screening program for all residents of BC, to reduce the burden of cancer in the province.

Optimizing research impact and building capacity for youth driven research within the learning health system of an integrated youth services initiative

Led by Dr. Christine Mulligan, this project will take place at Foundry, an integrated youth service initiative (IYS) providing comprehensive support to youth across BC IYS can improve youth mental health and substance use outcomes, issues afflicting 1 in 5 Canadian youth. Foundry operates virtually and in physical centres in BC, supporting youth through 5 service streams: physical and mental health, substance use, peer support and social services. Foundry is implementing a Learning Health System (LHS), a care model where data and learnings are used in real-time for continuous improvement and strong, equitable impact. This project is supported by a partnership between Foundry and the University of British Columbia, and jointly funded by the Canadian Institutes of Health Research (CIHR) and Michael Smith Health Research BC, as part of the CIHR Health Systems Impact Fellowship program. This research program will evaluate and enhance feedback loops between research, policy, and practice (iKT), focusing on building capacity for youth- driven inputs into Foundry research. The fellow will engage with Foundry knowledge users/creators to assess current iKT feedback loops at Foundry, highlighting areas for improvement, and finding solutions. This project will create a Youth Advisory Council (YAC) to give input into Foundry research, such as by co-developing (i.e., with Foundry youth) a plan to identify young people’s needs and co-designing new ways to track youth-reported outcomes. The YAC will co-develop a youth-centered iKT plan, and results will feed into the iKT feedback loops improved in this project and into the LHS, through arts-based methods, talking circles, and other publications. Importantly, the project’s outputs (iKT feedback loops and capacity for youth input) are sustainable and will develop beyond this program. This research program has immense potential for lasting impact on Foundry, and ultimately, the well-being of BC youth.

Discourse on COVID-19 and illicit drug toxicity on social media

This Health System Impact Fellowship is co-funded by ­CIHR Institute of Population and Public Health (CIHR-IPPH), Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


The illicit drug overdose crisis in North America has had a profound impact on individuals, families and communities, often leading to premature loss of life and lowering of life expectancy. Since 2016, British Columbia (BC) has been experiencing an epidemic of toxic drug supply leading to a large increase in the number of drug overdose events and related deaths. Coronavirus disease 2019 (COVID-19) and measures taken to limit the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, have directly and indirectly disrupted access to healthcare and social services worldwide, including harm reduction and social support services. Since the beginning of the COVID-19 pandemic, BC witnessed large increases in drug overdose related deaths, with 2021 being the deadliest year. This requires scaling up of existing interventions and introducing new, targeted interventions to address the overdose crisis. The level and type of response is also affected by the perception of the population towards health issues and debate on intervention options. The information available on social media could help decision makers understand the public discourse about opioid use and intervention options. In this project, the overall aim is to understand public perceptions and discourse related to overdose in social media using Artificial Intelligence (AI) methods and techniques to inform the overdose response.


Source: CIHR Funding Decisions Database

Impacts of COVID-19 pandemic on diabetes care among South Asian population

This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


COVID-19 and pandemic response measures implemented to limit its spread have resulted in various indirect health impacts due to the disruption of many preventative, diagnostic, and management services. The extent of their impacts on the diabetes care cascade are not known. South Asians, representing 25 percent of the visible minorities have highest burden of Type 2 diabetes. Higher incidence of COVID-19 was reported in neighborhood areas with higher density of South Asian population in British Columbia (BC) and Ontario. However, it is not known if diabetes care cascade among South Asians was impacted more than other population groups.


We aim to assess: a) The impact of COVID-19 pandemic on the diabetes care cascade, b) Differential impact in South Asians vs other population groups; c) Patient/provider perceptions of disruption of services.


We will use BC COVID-19 Cohort which integrates daily COVID-19 lab tests, case follow-up data, COVID-19 immunizations, hospital and ICU admissions, with demographic, healthcare utilization datasets (medical visits, hospital admissions, emergency room visits, dispensed prescription drugs) Chronic Disease Registry and socioeconomic data and data from BC SPEAK Survey. We will construct care cascade in pre-pandemic years and pandemic/post pandemic years and apply a combination of epidemiological and statistical techniques to investigate the stated aims. We will gather qualitative data based on interviews with diabetes patients and care providers to provide context and inform interventions to prevent further disruptions and optimize care.


This project will characterize the extent of disruption in services across diabetes care cascade and will identify characteristics of population most affected. We will provide evidence on disparities experienced by South Asians and identify strategies to mitigate the impacts of the COVID-19 pandemic or future similar health emergencies for individuals with diabetes.


Source: CIHR Funding Decisions Database

Characterizing and diagnosing the source of lead in drinking water in British Columbia

This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Ministry of Health (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


Lead exposure is an ongoing public health concern due to the association with cognitive deficits and neurodevelopmental disorders, particularly in children and infants. While several vectors of exposure (lead-containing paints and toys) have been reported, the prevalence of elevated blood lead levels has decreased over time with growing awareness. Nevertheless, contaminated drinking water has persisted as an important vector, especially in North America, where the most common source of lead is corrosion of plumbing materials, including lead services lines, brass fixtures and fittings, solders, and galvanized steel pipes. Striving to provide safe drinking water to its residents, British Columbia (BC) adopted Health Canada’s maximum acceptable concentration, 5 ug/L, in 2020. However, longitudinal data on lead exposure in water is limited in time and through consistent sampling approaches. The lack of consistent data represents a critical barrier to understanding the lead burden that is contributed from drinking water, thereby delaying appropriate prioritization of this exposure source for British Columbians, and limiting the implementation of mitigation strategies. The goal of this work is to provide the BC Ministry of Health with a comprehensive report of lead in drinking water in BC. This report will outline the risks associated with exposure and will seek to:

  1. Identify areas of concern.
  2. Determine whether concentrations are related to infrastructure (i.e. building specific, distribution materials), or water quality (e.g. pH, alkalinity, NOM) and treatment (e.g. corrosion control, disinfection).
  3. Use novel analytics to diagnose the source of lead in select water samples.
  4. Provide recommendation for remediation strategies where appropriate.

The expected deliverable is an extensive report of the above to foster evidence-based decision making.


Source: CIHR Funding Decisions Database

Analyzing regular and potential blood plasma donor preferences to improve resource allocation of Canadian collection services

This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and Blood Services Canada (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


Plasma is the liquid component of blood and is collected from donors. It is used for transfusions in hospitals, and for the manufacture of treatments that are used for patients with various chronic and life-threatening conditions. But we currently do not receive enough plasma from donors in Canada, and this will only get worse as the demand for plasma is increasing.


The Canadian Blood Service is considering how to best invest in new donor centres that will increase plasma donations. There are a number of different options to consider — from where to geographically place the centres, to what hours the centres should be open, to what incentives to provide such as free meals. All these options have different costs — from rents and material costs to staff salaries, and it can be hard to predict how impactful these different options will be on overall volume of plasma donated.


This project will survey existing blood donors and non donors to understand the impact of these different options on their willingness to donate. This will enable us to predict what locations, and features will result in the most plasma being donated. We expect people will say they will donate more than they actually do, but because people tend to do this in a predictable way, we will be able to adjust for this. The results of the surveys will be combined with costs in a model. For example, one option (e.g. a centre in a downtown) might be expected to obtain a 20 percent higher volume of donated plasma, but if this comes at an additional 50 percent cost, it might not be the best investment. The model will inform which options and locations are expected to provide the most plasma donation for the CBS investment budget.


Source: CIHR Funding Decisions Database

Developing a risk index for multimorbidity surveillance in British Columbia

This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


Multimorbidity is when an individual has two or more chronic diseases. But, behind this simple definition lies a complex phenomenon. Chronic diseases interact, and their combined health impacts can be greater than predicted by their individual impacts. Multimorbidity accumulates with age and affects the majority of senior citizens in Canada. For these seniors, multimorbidity increases health complications; including dementia, severe complications from COVID-19, and susceptibility to heat and climate events.


The BC Centre for Disease Control’s mandate is to provide accurate, timely and actionable health intelligence about population well-being and its determinants to decision makers in BC. This project follows this mandate, to improve knowledge of multimorbidity across BC. Multimorbidity is a huge challenge for our health care system because of its complexity. There are countless possible disease combinations, each with unique interactive effects on health. For this reason, most previous research has indexed multimorbidity by a simple count of the number of co-occurring diseases. But this approach loses granularity in understanding the nature of disease combinations.


Our goal is to use data clustering analyses to identify patterns of co-occurring diseases across the BC population and create a multimorbidity disease cluster index. We will apply this cluster index to measure how common different clustered disease combinations are across BC, and how different disease clusters relate to negative health outcomes. Finally, we will measure how disease clusters vary by sociodemographic variables like age, sex and gender, and socioeconomic status.


This project will enhance the ability of BC health authorities to identify opportunities for public health planning around multimorbidity, with knowledge of specific disease combinations and their sociodemographic context. Our project output will lay the foundation for enhanced population health surveillance and monitoring in BC.


Source: CIHR Funding Decisions Database

Exploring the pathways for legal regulation and recognition of genetic counsellors in British Columbia

This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Ministry of Health (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


Many types of healthcare professionals are legally regulated, meaning there are specific legal rules about the types of healthcare activities that they can do. This is to protect patients and the public from harm and to have a way to hold healthcare professionals accountable if they are practicing irresponsibly or inappropriately. Genetic counsellors are specialized healthcare providers who help patients and their families understand and adapt to the medical and psychological impacts of genetic conditions. Genetic counselling is a relatively new area of healthcare and there are not very many genetic counsellors in British Columbia. Because of this, genetic counsellors are not legally regulated at this time. To be able to explore the options for legal regulation of genetic counsellors in British Columbia, we need to better understand exactly what types of healthcare activities genetic counsellors do. To get this information, we plan to survey genetic counsellors to ask them which healthcare tasks are part of their jobs and if they expect that this will change in the future. We hope that this information can be used to decide when and how to legally regulate genetic counsellors in British Columbia to improve the safety of and access to clinical genetic services in the province.


Source: CIHR Funding Decisions Database