Research Pillar: Health Services

Supporting Success: The Role of Mentorship in Increased Health Services Research Capacity

Research programs in Canada embrace mentorship as a way to increase research capacity, with experienced researchers mentoring more junior investigators. The three major research granting agencies in Canada (CIHR, SSHRC and NSERC) identify mentorship of new researchers as integral to research training. But few questions have been asked about how to make mentorship effective. For example, is an effective mentor someone who oversees career development, or provides guidance for a trainee? Dr. John Egan is evaluating how mentorship works in collaborations between university and community-based researchers. He is examining how mentors and their trainees experience mentorship, in a program jointly funded by the Canadian Institutes of Health Research and MSFHR. This research should identify what creates successful, productive mentoring, and lead to evidence-based practices and policies for effective mentorship

British Columbia Transient Ischemic Attack Project

A transient ischemic attack (TIA) occurs when there is a temporary disruption of blood supply to the brain. Damage from a TIA is temporary and reversible, but the experience is an important warning symptom for stroke, which is a major cause of death and long-term disability. Patients have a five to ten per cent risk of having a stroke within a week of a transient ischemic attack. Patients with TIA symptoms often go to the emergency department for evaluation, but there is no universally accepted strategy for managing TIA in B.C. Emergency Departments (EDs). A major challenge has been the lack of a system for determining which patients are at high risk for having a stroke and warrant urgent investigation and treatment. Dr. Devin Harris is evaluating the effectiveness of a clinical guideline for standardizing TIA care in EDs. This evidence-based guideline is being implemented as a pilot project in six B.C. emergency departments and will then be expanded to all 92 EDs in the province. Devin is examining physician adherence to the guideline and the impact on patient outcomes. This information will be used to develop a model for predicting which patients are at high risk of stroke after TIA, leading to better preventive and treatment options.

Dying for choices: decision-making in end-of-life care

Every year more than 185,000 Canadians die in acute-care settings. Previous research has shown that patient choices regarding care are extensively influenced by factors inherent in the place of death. However, no Canadian research has examined how end-of-life care (EOLC) decisions are influenced and shaped through these factors. The focus of Marian Krawczyk’s research is to examine EOLC decision-making within acute-care settings, specifically in regards to the use of life-extending technologies. Her study examines factors that are overlooked in existing research including the location of communication when discussing EOLC options, differing medical models of palliative care, doctor-patient communication, and the social capital and economic resources of patients. By providing data that examines communication in EOLC in British Columbia, this research seeks to strengthen the ability of health care providers, patients and families to effectively communicate and negotiate patient care choices before and during acute care settings. The research will also increase the ability and efficiency of policy makers in the delivery and distribution of health services. Finally, it may help improve communication and decrease consumer-driven health costs.

Bayesian propensity score analysis for pharmacoepidemiologic research

Data on prescription claims, health services provided, and hospital discharges are routinely collected in the Canadian health care system for the management of health services. This information is valuable for observational research assessing the effectiveness and safety of drug therapies, allowing more rapid and cost-effective investigations. In addition to yielding large sample sizes with long periods of follow up, they also better reflect the spectrum of medical practice in large populations compared to randomized clinical trials. However, because study participants are not randomly assigned to treatment and control groups through this methodology, findings may be biased if there is inadequate control of the variables. There is a need for new statistical tools to analyze healthcare administrative data. Lawrence McCandless is developing and investigating a new statistical method called a Bayesian propensity score analysis. Through computer simulations, mathematical techniques and models for drug prescribing patterns, the Bayesian analysis will improve the validity of observational investigations of the effectiveness and safety of drugs using large health care administrative databases.

A population health-based approach to nurse human resource planning in BC

Health human resource planning is identified repeatedly as the foremost priority in the field of health services research. Current approaches to health human resource planning include the need to move beyond “head counts” of health care providers to more robust and dynamic approaches that include consideration of many different factors. Improved planning for the registered nurse workforce is of particular concern, requiring an understanding of the influence of contextual issues such as the impact of population health trends, changing demographics and policy directions on human resources planning initiatives. Sandra Regan’s research is focused on identifying the numbers and characteristics (education, competencies, employment patterns and roles) of the registered nurses needed to meet the health care needs of British Columbians. In order to determine the numbers and characteristics of registered nurses required in BC, her research will combine existing registered nurse databases with population health data, interview data and focus group data from key players in the health care system including consumers. This research will assist decision-makers such as government, employers and educational institutions to understand the implications for future planning of health care services provided by registered nurses. It will also contribute to understanding how to better plan for other health care providers (e.g. pharmacists, physicians).

Economic studies in BC seniors at high risk of injurious falls

Falling and fall-related injuries are a major health concern for the elderly. It is estimated that 40 per cent of people over age 75 will experience a fall at least once per year. This is a health issue with significant costs to the healthcare system, and to the elderly population. Fall prevention programs exist; however, research and evidence on the cost-effectiveness of these programs is lacking in Canada. The analysis of the costs and cost effectiveness of health technologies is becoming an increasingly important issue in healthcare decision-making. If economic evaluations are missing, decision-makers will lack an important aspect for fully informed decision-making. John Woolcott is conducting one of the first Canadian-based costing assessments of the impact of falls and is investigating the cost effectiveness of fall prevention programs. John is determining the direct and indirect costs of injurious falls in BC and evaluating the cost-effectiveness of existing interventions currently in place to reduce seniors’ falls. He is also focusing his research on how injurious falls affect the quality of life of 400 seniors in BC. John’s research will further educate the health care community regarding the substantial costs of falls and will further inform decision-makers regarding cost-effective interventions.

An investigation of injection drug use and HIV infection among drug using youth

Illicit drug use remains a major public health concern throughout Canada, and available evidence indicates that injection drug use and crystal methamphetamine use is steadily increasing among youth. Youth whose social or economic base is on urban streets are particularly vulnerable to illicit drug use, HIV infection and other adverse health outcomes. Adolescence and young adulthood are critical times with respect to illicit drug use and HIV infection, as it is a period during which many behavioural patterns that pose or offset future health risks become established. However, there remains a major gap in our understanding of factors that may facilitate or protect youth from initiating injection drug use, and there is a consequent lack of information around how to shape related interventions. Thomas Kerr is investigating the impact of psychosocial characteristics (e.g. self-efficacy and depression) and crystal methamphetamine use on patterns of illicit drug use, HIV risk behaviours and HIV incidence among drug users aged 14 to 24. Drawing data from two large population-based cohort studies that will follow 500 non-injecting drug using youth and more than 1000 HIV-negative injection drug users, he is addressing a growing threat to the health of many Canadians.

Priority setting and resource allocation in the Vancouver Island Health Authority

With limited resources in our health care system, difficult choices must be made in how health authorities prioritize services and allocate resources. Recent research has shown that decision-makers in health authorities face two sets of impediments in this task: a lack of skills in these processes, and an organizational culture in health administration that implicitly supports allocation based on historical patterns. Program budgeting and marginal analysis (PBMA) is a framework designed to assist decision-makers in weighing evidence from numerous sources to determine how resources might be allocated to improve health gain or to better meet other relevant criteria. To facilitate organizational adoption of PBMA as an alternative decision-making process, further research is required to develop strategies for implementation, as well as to drive key methodological aspects of the process. Craig Mitton is addressing these issues by applying PBMA across service areas in the Vancouver Island Health Authority (VIHA). While advancing key aspects of priority setting through the introduction of PBMA within VIHA, he is also facilitating skill-building among stakeholders in the application of the new decision-making process. He is also evaluating its implementation, which will not only refine the process for VIHA, but also contribute to the literature on priority setting in health organizations.

Priority setting methods for cancer control and care

Priority setting is the focus of health economics—a branch of economics concerned with issues related to the scarcity of health care resources. With cancer expected to be Canada’s primary cause of death by 2010, priority setting in cancer control and care is imperative. An aging population, rising health care costs and increasing demand have resulted in the need for identifying effective and cost-effective ways to improve cancer patient outcomes. Basing his work on an internationally-recognized economic framework for priority setting (called Program Budgeting and Marginal Analysis), Dr. Stuart Peacock is developing new evidence-based methods to help health care decision-makers determine the most effective cancer interventions to fund. His research will develop three significant innovations within this framework: methods to address improvements in life expectancy and quality of life from health programs; methods to address community preferences and equity concerns; and measures to evaluate priority setting and evidence-based decision-making. Dr. Peacock’s goal is to develop an evidence-based framework for decision-making in cancer services that is transparent, explicit and accountable.