Better Serving People with Multiple, Complex Needs in BC through Health System Impact.

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


The aim of this research project is to better understand and address the health needs and service requirements of people with multiple, complex needs under the purview of Community Living British Columbia (CLBC). The proposed research project will build on existing research and fill important gaps in knowledge regarding the health of people with a multiple complex needs designation and effective service delivery mechanisms at points of intersection with the healthcare system. This research project will advance CLBC’s research efforts through two key objectives. The first is to better understand the health-related needs of this population, which includes an analysis of health-related contacts (type and frequency), outcomes, and costs associated with this population. In BC, much is not known about the health-related needs of this group.  The second objective is to identify and learn from promising practices in BC — specifically, what is being done that works for this population and why, with particular attention to issues of sustainability and scalability. Although findings from CLBC’s qualitative research highlight the need for significant systemic change in the delivery of services for people with multiple complex needs, it also identified “pockets of excellence” in BC where local or regional solutions have emerged as examples of practice excellence. Through this objective, I will focus on services that directly intersect with the healthcare system (e.g. acute care, residential detox/treatment, etc.) and address underlying social determinants of health, including, for example: homelessness, poverty, and issues of gender and race (Indigenous people). The research will include an evaluation of selected services. In addition, an inventory of services for the multiple, complex needs people in BC will be developed.


End of award update: December 2021


Impact goal

To inform policies and practices so that people with intellectual and/or developmental disability (IDD) and multiple, complex needs (MCN) receive high-quality service and care from Community Living British Columbia (CLBC).


Impact summary

Dr. Cook’s research led to key academic and knowledge mobilization deliverables, such as a plain-language summary report of key findings and recommendations related to the health and service delivery needs of people living with IDD and MCN. The report will help inform future policies and practices. Stemming from the research and recommendations, CLBC will establish a data innovations project to help the organization better understand integrated and coordinated care across health systems for people with IDD/MCN. Dr. Cook’s research has helped reinforce a cultural shift within CLBC toward broad and long-lasting changes that will better serve people with IDD and MCN.


Read more about the impact of Dr. Cook’s fellowship in the CIHR HSIF 2017-19 Embedded Research Impact Casebook.

Interpreting and addressing barriers impeding effective care transitions for women diagnosed with breast cancer in British Columbia

The number of Canadians diagnosed with cancer is rising with a growing and aging population and we need to ensure our healthcare system is equipped to meet this growing demand. As the most common female cancer worldwide, breast cancer is the second leading cause of cancer deaths in Canadian women. In recent decades, advancements in breast cancer screening and treatments have resulted in approximately 87% of Canadian women diagnosed with breast cancer surviving 5 years after diagnosis. Increased survival rates are due in part to adjuvant endocrine therapy (AET) (e.g., tamoxifen), which is used to treat early-stage, hormone receptor-positive breast cancer, representing the large majority of breast cancer diagnoses. Women prescribed AET are recommended to take this medication everyday for 5-10 years depending on their diagnosis, which results in the need for increased follow-up care over a long period of time. Previous research, however, has shown there are many issues associated with transitions in care, particularly as breast cancer survivors move from receiving care from their oncologist back to seeing their family physician or nurse practitioner in the community. The objective of this project is to improve transitions in care to better support women diagnosed with breast cancer and also the healthcare providers that deliver care to these women. The goal is to meet the supportive care needs of breast cancer survivors as they transition through the healthcare system to support them in living well beyond their breast cancer diagnosis.

Investing wisely: using economic modelling to optimize public health strategies to reduce harm from alcohol, tobacco and cannabis and optimize benefits 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.


Substance use costs British Columbia $4.9 billion in 2014, of which 70% was due to alcohol and tobacco. These estimates include costs related to the use of health care resources, productivity losses, criminal justice, and other direct costs such as accidents, research and prevention. Broader societal costs not included in these estimates relate to inequities, marginalization and hindered social development.  This project aims to develop a model to evaluate the economic and social impact of legal substance use harm prevention in British Columbia. Evidence on economic consequences and how public health programs can minimize costs and harms from substance use is important for policy makers, who need to consider the health system priorities against efficiency, scalability and sustainability of interventions. The challenges to developing comprehensive economic evaluations in public health are well known. In the area of substance use, these pertain to the multitude of the socioeconomic determinants that influence use – such as employment, income, social exclusion, and hopelessness – and the difficulty of measuring broader benefits including family wellbeing, community development and equity gains.   This fellowship will facilitate collaboration between knowledge users and academics with the aim of optimizing investment in the area of alcohol, tobacco and cannabis harm prevention in BC. It will provide the Ministry of Health with tools to implement efficient priority setting that aligns with the institution’s values and development goals. This will be achieved through important methodological advances to allow evaluations to account for the broader societal impact of preventing harm from legal substance use in BC. As a result, this fellowship will sustain future research in health economics with an increased ability to respond to policy makers’ needs when it comes to priority setting.

Building Capacity for Surveillance and Policy Development: Health Impact Assessments of Air Quality in Northern British Columbia

In Northern British Columbia, a region rich in natural resources, there has been a rapid expansion of resource extraction projects across the region in recent years. While generating economic growth for local communities, this has also led to concerns among health practitioners and community members about the potential health risks associated with declining air quality due to increased industrial emissions. In the BC Northwest, in particular, projections indicate that sulphur dioxide emissions will likely increase in the Kitimat airshed due to multiple new industrial projects and expansion of existing projects.Timely information about air quality and associated health risks is important for developing public health policies, to prevent potential negative health impacts, and for planning at both local and regional levels. The objectives of this project are to 1) conduct a health impact assessment of impacts of SO2 emissions on human health in the Kitimat region; 2) make recommendations for development of effective surveillance tools to assess air quality health impacts in the region; and 3) review how local and regional policy makers use environmental health impact information for decision-making.This project will directly support Northern Health's organizational impact goal of healthy people in healthy communities, through promoting and protecting healthy environments, and through helping to build regional capacity for conducting health impact assessments and surveillance.

Evaluating the response to British Columbia’s overdose crisis within Vancouver Coastal Health: Moving research into practice

The opioid crisis has been hardest felt in British Columbia (BC), which declared a public health emergency in 2016. Last year, there were 1510 drug overdose deaths recorded in BC, which represented 4.5 times the deaths from motor vehicle accidents. The overdose crisis has been largely driven by increasing contamination of the illicit drug supply with powerful synthetic opioids (e.g., fentanyl). Despite efforts to expand harm reduction services and treatments for opioid use disorder, these have had limited success in curbing the current crisis. Innovative strategies to mitigate the crisis have become an urgent public health priority. This includes a critical need to evaluate the response to the overdose crisis to help develop and implement a comprehensive addiction treatment program across BC and ultimately prevent future drug-related fatalities. Vancouver Coastal Health (VCH) provides services to more than 1.25 million residents in BC (nearly 25% of the population), and has been a primary player at the heart of the overdose crisis response. As such, alongside the newly implemented VCH Regional Addiction Program, VCH has identified key policy-related challenges that the proposed work will seek to address: prevent fatal overdoses, reduce drug-related harms, increase access to low barrier services, and improve integration of harm reduction and treatment. The proposed work will consist of several overlapping components to achieve the overarching goal to establish comprehensive and integrated addiction care programs across the region. This will include evaluating the impacts of 'naturally occurring' interventions (e.g., supervised consumption sites) and efficacy of novel clinical therapies, conducting health system and program evaluation to identify gaps in care and healthcare provider capacity, and engaging in integrated knowledge translation to mobilize research into evidence-based policies and practices across the health system.

Evaluating and optimizing rural and urban lesbian, gay, bisexual, transgender, queer, intersex, and Two-Spirit (LGBTQI2S) engagement with hospice and palliative care in the Island Health Region

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


Existing research focused on the experiences of gay and lesbian older adults with the health care system report that there is a general distrust and reluctance to access healthcare based upon the cumulative effect of discrimination over the life course. At present, while 75% of Canadians have indicated they would like to die at home, 45% of Vancouver Island residents die of in acute care. Clearly there exists a service gap and it appears possible that such a gap may be larger in the LGBTQI2S community. It is therefore vital to explore the level of LGBTQI2S engagement with hospice and palliative care, in order to ensure this population is not further marginalized in end-of-life. Victoria Hospice and Island Health will facilitate access to healthcare service providers, and I will recruit rural and urban LGBTQI2S participants and their families throughout the Island Health region via the relationships I have built with community gatekeepers. A Participatory Action Research strategy will be used and a Community Steering Committee of older LGBTQI2S people representing various geographies as well as sexual orientations and gender identities will be established. The Community Steering Committee will become an integral part of the Project Working Group, comprised of healthcare service providers, Island Health, Victoria Hospice, and the University of Victoria supervisory team and will be integrated into every step of the research process including development of research questions, refining research objectives, participant recruitment, data collection and analysis, evaluation of our findings, and knowledge translation.

A scoping review of literature on different models of allocating funds to facilitate integrated care

Health Research BC is providing match funds for this research project, which is funded by CIHR’s Strategy for Patient Oriented Research (SPOR) Primary and Integrated Health Care Innovations (PIHCI) Network – Knowledge Synthesis Grants.


Jason Sutherland is Professor in UBC’s Centre for Health Services and Policy Research in the School of Population and Public Health. He is also a Scholar of the Michael Smith Foundation for Health Research.


This is a two-province research team, though the scope of the project is examining integrated funding models across the globe. Little is known regarding how other countries have developed and implemented policies for supporting integrated healthcare. This study will conduct an extensive review of the literature and synthesize the evidence regarding the scope and breadth of policies and their effectiveness to improve integration of healthcare across sectors of the delivery system.


Knowledge translation activities:

  • Policy roundtable to disseminate findings to knowledge users in Calgary, Alberta
  • Policy roundtable to disseminate findings to knowledge users in Vancouver, British Columbia
  • Patient Groups Compensation (honorarium, travel cost, parking) in Calgary, Alberta
  • Patient Groups Compensation (honorarium, travel cost, parking) in Vancouver, British Columbia
  • Open Access Publication jointly by University of Calgary and University of British Columbia
  • Webinar and YouTube video preparation by the University of British Columbia

The team expects to share findings of the project with key public stakeholders regarding attributes of policy and delivery systems that integrate sectors of the healthcare delivery system to improve care and outcomes.

End of Award Update – April 2022

Most exciting outputs

In my opinion, the most exciting outputs from this project include the development of a multi-institution collaborative to collect surgical patients’ health and health outcome information. The information that this project has generated has led to innovative insights into the value of operative treatment for the patient, health system and government. This information has led to creative ways of re-configuring access to elective surgery, improving mental health in addition to physical health, and training students on the importance of patients’ perceptions of their health.


Impact so far

The impact of this project is local, national and international. Locally, operative patients, the health system and the province are benefiting from understanding the gain in health attributable to surgery. Nationally, this work is garnering significant attention from outcomes researchers and health systems seeking to understand variability in health and healthcare outcomes from surgical care. Internationally, this work is attracting interest from countries with public health systems with similar problems in accessing surgical care and cost-efficiency of healthcare delivery, international agencies, such as the International Consortium for Health Outcomes Measurement (ICHOM), and academic institutions.


Potential future influence

The project is continuing to expand with financial and in-kind support from new organizations. In 2021, PHSA and the Heart and Stroke Foundation (B.C.) began funding the expansion of the project.


Next steps

  1. Continued expansion with existing and new collaborators.
  2. Renewed knowledge translation with government and healthcare organizations.
  3. Attract new funding from national and provincial research organizations.

Useful links

3D bioprinting personalized neural tissues for drug screening

Bioprinting can produce living human tissues on demand, opening up huge possibilities for medical breakthroughs in both drug screening and developing replacement tissues. The Willerth lab was the first group in the world to use the cutting edge RX1 bioprinter from Aspect Biosystems to bioprint neural tissues similar to those found in the brain using stem cells derived from healthy patients. Similar tissues can be printed using stem cells derived from patients suffering from Parkinson’s disease, recapitulating the disease phenotype in a dish. These highly customized, physiologically-relevant 3D human tissue models can screen potential drug candidates as an alternative to expensive pre-clinical animal models.


This project will bioprint both healthy and diseased neural tissues using our novel bioink in combination with Aspect Biosystems’ novel trademarked Lab-on-a-Printer system and evaluate their function. We will then validate these tissue models as tools for drug screening by exposing them to compounds with known toxicity to brain tissues.


Dr. Stephanie Willerth has over 16 years of experience in the area of biomaterials and tissue engineering, making her the ideal choice to lead this project. This project will lead to better health outcomes for patients suffering from neurological diseases and disorders, which account for 6.7 percent of the healthcare burden in Canada and improve the quality of life for BC residents suffering from such diseases.

End of Award Update: December 2022


Most exciting outputs

We developed a prototype of our BrainPrint bioink for bioprinting human brain tissue models. This ink makes it easy to use a 3D bioprinter to generate human brain tissues in a rapid and reproducible fashion.


Impacts so far

The project led to the creation of Axolotl Biosciences – an award-winning spin-off company – that is commercializing BrainPrint with the goal of a product launch in 2023.


Potential future influence

We are currently using BrainPrint to generate models of Parkinson’s disease and Alzheimer’s disease.


Next steps

We are building upon this work in lab to further characterize our neural disease tissue models. Axolotl is beta testing BrainPrint with users from across British Columbia.


Useful links

Biomarker tests to diagnose and prognose acute exacerbations of chronic obstructive pulmonary disease

There are 2.6 million Canadians with Chronic Obstructive Pulmonary Disease (COPD), representing 17% of adults between 35 and 80 years of age. COPD is a disease characterized by progressive loss of lung function that leads to shortness of breath, poor quality of life, reduced productivity, emergency visits, hospitalizations and deaths. The World Health Organization estimates that COPD will be the 3rd leading cause of death worldwide by 2030, accounting for more than 7 million deaths/year and 11,000 deaths/year in Canada. Most of the deaths and suffering occur during 'lung attacks', when patients' COPD flares-up, in response to a respiratory tract infection. Lung attacks cost the Canadian health care system nearly $3 billion each year in direct expenditures.

There are no tests that doctors can use to diagnose lung attacks and no tests that can guide doctors on how these lung attacks should be treated. In this project, we will develop lab tests to enable rapid and accurate diagnosis of lung attacks and to help doctors figure out who will have another lung attack in the near future, so pre-emptive therapies can be implemented to avoid future attacks. These tests will prevent hospitalizations and deaths from COPD and help patients to receive the right therapies at the most appropriate times.

Technology for image-based screening to enhance protein production

New medicines being developed to treat complex diseases, such as cancer, multiple sclerosis, and rheumatoid arthritis are increasingly becoming large and complex molecules, such as proteins. These molecules must be produced using cells grown in a laboratory or production facility. A key bottleneck in the development of such new medicines is producing sufficient quantities of these molecules for various stages of rigorous testing to ensure safety and efficacy. This project will develop a technology to generate better producer cells in order to increase their productivity. This capability will dramatically reduce the timelines required to develop protein-based medicines, resulting in more available and cost-effective medicines for patients.