Health care reform is bringing about significant changes in the way health services are structured and delivered to children with chronic health conditions. Research suggests that the availability of health care services and the quality of interactions within the health care system have an immense impact on the lives of these children. But services are often fragmented, shaped by priorities that compete with children’s needs, or are not accessible to all families. Gladys McPherson’s research focuses on how the structure and organization of health care, as well as the nature and quality of interactions within the health care system, shape the lives of children with chronic health conditions. She is exploring how the principles and priorities in the health care system influence the lives of children with chronic health conditions, and the impact of their experiences with the system on their well-being, growth and development.
Research Pillar: Health Services
Reducing the injury of community homecare workers
Given that a growing number of elderly people choose to continue living at home, but need some support to live independently, community homecare services are an increasingly important part of our health care system. Recent reports indicate that the community healthcare workers who provide these services have the highest injury rate among all health care professionals in BC. With his postdoctoral research, Dr. Il Hyeok Park aims to reduce the injury rate and the cost of injuries to the health system. Dr. Park is investigating three interventions to reduce injuries: educating community healthcare workers about proper lifting techniques, using a new assessment tool to gauge possible risks at work sites, and providing mechanical lifting equipment. This project should help improve community healthcare workers’ health and the quality of homecare services.
Effects of context on coping responses of parents in universal newborn hearing screening programs
Early identification of hearing loss in newborns is associated with improved cognitive, speech, language, and social-emotional outcomes. Yet a high proportion of parents withdraw from universal newborn hearing screening programs following the first screening, even if the screening indicates a need for further testing. This is thought to be due, in part, to parents’ anxiety and stress over the initial results. Brenda Poon is investigating how the screening program environment affects the way parents cope with the stress of discovering their newborn child may have hearing loss. Based on her findings, she hopes to recommend developing services in universal screening programs that are sensitive to parents’ emotional and coping responses at each stage of the screening. With improved services in place, parents may be less likely to withdraw their child from screening programs before the infant’s hearing status can be confirmed, allowing for earlier intervention.
Evaluation of the quality of supported employment programs' implementation in BC and of vocational outcomes of people with serious mental health problems
The World Health Organization estimates that 90 per cent of people with mental health problems who are ready to enter the workforce are unemployed. Dr. Marc Corbière is examining the factors that help people with a serious mental illness obtain and maintain a job. He is assessing factors such as self-esteem, social supports, past work experience, barriers to employment, psychiatric diagnosis, the severity of mental health problems and cognitive functions. Dr. Corbière is also evaluating the implementation of supported employment programs for people with mental illness in BC. This research will help programs tailor vocational support services to the needs of mental health consumers to ensure more people with mental illness are able to find and keep a job.
The demand for hereditary cancer services
The Hereditary Cancer Program at the BC Cancer Agency provides genetic testing and counseling services. The demand for these services in BC depends on many factors, each of which is subject to change. Factors include the growing knowledge in basic, applied and social sciences relating to hereditary cancer; the size of BC’s population and its characteristics in terms of age, ethnicity and family size; the evolving criteria by which people are deemed eligible for services; and people’s desire for these services. Through his research, Dr. Chris Bajdik is determining the demand for hereditary cancer services in BC and predicting how this demand may change in the future. He has created a computerized simulation model of the BC population, based on information about demography, cancer epidemiology and etiology, genetics, genetic technology, and human behaviour. The results from this model will help the BC Cancer Agency plan its services and assess the health benefits and costs of its Hereditary Cancer Program.
Secondary prevention – the gap between evidence and practice
Cardiac disease remains the leading cause of death in Canada. A significant portion of cardiac health care resources are expended on acute interventions such as clot-busting drugs, angioplasty and bypass surgery. However, there is a lack of research on the use of proven strategies – known as secondary prevention – to prevent patients from experiencing subsequent coronary events such as a heart attack. Dr. Karin Humphries is a leading investigator in the area of cardiac health outcomes and the epidemiology of cardiovascular disease. Dr. Humphries is studying how BC patients with heart disease are monitored and how many are using aspirin, beta-blockers and cholesterol-lowering drugs as part of their efforts to reduce their risk of further coronary events. Eventually, she hopes to design a clinical trial to assess new approaches to increase the use of secondary prevention strategies.
Statistical techniques for genomic research
Genomics is the study of how the information contained in a genome gives rise to organisms and their functioning. This relatively new field of research analyzes vast amounts of data to uncover biological trends that help scientists understand how genes function in living systems. Dr. Jenny Bryan is working to develop new quantitative methods and statistical frameworks required for analysis of large functional genomics data sets. Her work addresses how researchers can find patterns and themes in complex, multidimensional genomic data. With colleagues, Dr. Bryan has pioneered methods of statistical gene expression analysis and has created a software program to implement these methods. Her software is currently being used by the world’s second largest biotechnology company. After she completed her PhD in 2001, Dr. Bryan elected to join Vancouver’s burgeoning computational biology and genome sciences community. Along with her dual appointment in the UBC Biotechnology Laboratory and Department of Statistics, she is also a faculty member in the MSFHR/CIHR Strategic Training Program in Bioinformatics.
Children’s mental health: Linking research evidence and policy making
How can we ensure that public policies in children's mental health reflect the best available research evidence about what works to help children. This is the research focus for Dr. Charlotte Waddell, who is exploring ways to strengthen the links between new research knowledge and policy making. At any given time, up to 20 per cent of children experience mental health problems that affect their emotions, learning and behaviour, and interfere with their development. This creates a large burden of suffering for these children, their families and their communities. However, there are often few links between the realms of research evidence and policy making in children's mental health: research evidence is often poorly communicated to policy makers, and policy makers often make decisions that contradict the best available research evidence. Dr. Waddell is investigating the respective needs and working cultures of researchers and policy makers, and will suggest and test new ways for these two groups to share information better. The goal of her work, supported by MSFHR, the Canadian Population Health Initiative and the BC Ministry for Children and Family Development, is to ensure that more effective interventions are available to help children at risk. Her findings will apply to many other health arenas where improved links between research and policy making are also needed.
Improving patient safety: Costs and effects count
Health economist Dr. Rebecca Warburton is analyzing the costs and effects of interventions to reduce the accidental harm caused by health care. Her research aims to provide a rational basis for establishing priorities among policies and programs for reducing errors. The US Institute of Medicine’s estimate that 44,000 to 98,000 Americans die every year as a result of preventable hospital mistakes has raised public awareness of errors in health care and focused attention on reducing risks and harm to patients. However, most Canadian hospitals are overwhelmed by the number of safety improvements suggested by experts or demanded by regulatory bodies. Limited resources, and lack of information about the likely costs and benefits of proposed changes, means that few safety strategies are actually implemented, and most changes are not well evaluated. Dr. Warburton’s research, conducted in partnership with the Vancouver Island Health Authority, compares the costs of patient safety improvements with the outcomes in terms of standard units such as life-years or quality-adjusted life years gained. Before joining the University of Victoria in 1999, Dr. Warburton spent 11 years in policy and research positions with the BC Ministry of Health. She is currently assessing the effectiveness of BC’s Premium Assistance Program, which subsidizes medical premiums for low-income residents, and assisting in the evaluation of BC’s Clinical Practice Guidelines and Protocols.
Improving Therapeutic Decision-Making During Active Clinical Practice
The ultimate goal of Laura Esmail’s research is to improve the management of medication use and patient outcomes. Studies estimate that 4.3% of hospital admissions in industrialized countries are due to preventable adverse outcomes of drug therapy. To begin to address this problem, Laura developed and tested a decision-making network aimed to improve physicians’ drug therapy decision-making. The conceptual framework of this network was based on the theory of cognitive apprenticeships: the process of understanding concepts through engaging in authentic activities and actual practice. Through linking family physicians with clinical pharmacists using cellular-telephone instant group conferencing, Laura attempted to create a continuous, contextual, social learning environment in which therapeutic expertise and experience could be shared and acquired at the time of patient care decision-making. This network ultimately aimed to facilitate the collaborative decision-making process that often takes place between health care professionals during hospital medical rounds. Results of her study concluded that cellular-telephone instant group conferencing between family physicians and clinical pharmacists is a useful method for influencing and assisting with drug therapy decisions at the time of patient care decision-making. Further modifications to the network are necessary before feasibility can be fully assessed. This work is an important contribution towards the understanding of decision-making systems that can improve drug related morbidity and mortality and help advance patient care.