Research Pillar: Health Services

Evaluation of the Residential Program Care Delivery Model

CDM was launched in Fraser Health in July 2010, with plans to implement the model across all residential care beds in the Health Authority. The model consists of three inter-related aspects: staff mix, funding methodology and direct care hours. CDM sets a goal of reaching 3.36 direct care hours per resident per day across Fraser Health by targeting residents, their families and staff in residential care programs in FH-operated facilities. The evaluation project will examine Phase 1 of the implementation of CDM (July 2010 to January 2011) and will include monitoring funding indicators as well as quality of care indicators.

Evaluation of Collaborative Practice Project

The focus of this evaluation program will be the impact of Collaborative Practice on three residential facilities: Banfield Pavilion, Evergreen House and Minoru Residence. Collaborative Practice Program has two key characteristics: 1) it is an approach to matching staff to patient needs through participation of nurses, unions, professional practice and clinical and operational leaders; 2) it promotes a team-oriented model of nursing care. The purpose of the evaluation will be to assess and compare the impact of the program at these three sites on health human resources and patient outcomes.

The evaluation of Collaborative Practice will include six main areas of focus:

  •     impact on clinical outcomes
  •     impact on health human resources
  •     nursing staff engagement
  •     consistent collaborative approach to care
  •     impact on clinician roles
  •     productivity

Development of Clinical Standards of Care for Huntington disease Intermediate Allele Predictive Test Results

Predictive testing for Huntington disease (HD) has been available since 1986. This genetic test has the ability to ‘predict’ whether individuals will develop HD in their lifetime and possibly pass the disease onto their children. Some individuals who undergo predictive testing receive an unusual test result, called an ‘intermediate allele’ (IA), which differs from a gene positive or negative result. While individuals with an IA will never develop HD themselves, there remains a risk that their children or grandchildren could subsequently develop the disorder. Currently, knowledge gaps exist with respect to IA for HD. Specifically, the current International Predictive Testing Guidelines do not address the possibility of this result, nor are the complexities surrounding this result acknowledged in the literature. Alicia Semaka’s research, which is the largest empirical study on HD IAs to date, will not only address these gaps, but also inform the development of clinical standards of care for communicating IA results during predictive testing. The specific objectives of Ms. Semaka’s research are to determine the prevalence of IAs in British Columbia’s general population; determine quantified risk estimates for the likelihood that an individual with an IA will have a child who will develop the disease in their lifetime; and lastly, describe the psychological and social impact of receiving an IA result. Collectively, the three objectives of this unique, multidisciplinary study will provide the foundation for the development of clinical standards and practice recommendations for IA predictive test results. These standards will help ensure that this subset of patients receive appropriate information, support, education and counselling throughout the predictive testing process.

Optimal timing of delivery for pregnancies with pre-existing hypertension

Chronic high blood pressure in pregnant women is associated with serious maternal and fetal complications such as poor growth, early separation of the placenta, and stillbirth. Consequently, the recommendation has been made that all women with chronic high blood pressure be considered candidates for induced delivery to reduce the risk of complications that may occur with allowing pregnancies to continue to later gestational ages. However, the optimal gestational age at which the infants should be delivered is currently unknown: delivering too early may increase the risk of respiratory complications for the infant at birth, while delaying the induction of delivery increases the risk of stillbirth. Dr. Hutcheon’s research centres on the development of a methodology to help determine the optimal gestational week for delivery. Data on maternal characteristics and pregnancy outcomes obtained from the US population birth registry as well as Canadian Birth Registries will be reviewed with a focus on the occurrence of either a serious birth complication for the newborn (such as seizures or need for prolonged assisted ventilation), or stillbirth. Among women with pre-existing high blood pressure, the risks of a poor pregnancy outcome will be calculated for each week of gestation between 36 and 42 weeks of pregnancy. Statistical models will be used to determine the gestational age range for birth during which risks to the infants are lowest. These analyses will then be repeated to determine the timing of delivery that minimizes risks of serious complications for the mother. With childbearing at older maternal ages increasing in Canada, the number of pregnancies complicated by high blood pressure is expected to increase. The results of Dr. Hutcheon’s project will help provide guidance to physicians as to the best time to deliver pregnancies complicated by pre-existing high blood pressure and, as a result, help minimise the number of adverse pregnancy outcomes in the Canadian population.