2023 – Health Research BC

Health Workforce Development, Support, and Retention in Learning Health Systems: Co-creation of Innovative Approaches for Engagement in Research in Long-Term Care

Health Research BC is providing matching funds for this project, which is funded by the Canadian Institutes of Health Research’s Winter 2023 ICS Planning and Dissemination Grant – Supporting & Strengthening the Health Workforce stream.

It is important to attract, keep, and support the best health workforce in long-term care homes since the conditions of work impact the conditions of care for residents. There is also a need for more skilled staff because the level of care of residents has become higher and more complex due to their mix of health and social care needs. National long-term care service standards suggest to offer the best education to prepare for starting work and ongoing training to promote a culture of learning, continuous quality improvement and mental health and wellbeing of staff. Although used in a limited way in select countries and regions, promising approaches exist to support education, research, and best practice in care homes such as the ‘Teaching Nursing Home Model’ and MicroResearch of small, locally driven health research teams. Our research team is based in long-term care at Fraser Health, the largest regional health authority in British Columbia. We are in the early stages of planning research to attract, keep, and support the health workforce in long-term care homes through co-creation of smart approaches for partnering in research. The planning activities will include a review of relevant reports and conversations with people from organisations that have adopted smart models for doing research in care homes. Also, one-on-one conversations with key informants and group dialogue with the key informants and relevant stakeholders will be held to learn from their experiences. These activities will help to build a network of research collaborators, including health providers, interested in working together on long-term care research. Also, meaningful research priorities and promising approaches for research will be identified to inform the planning of a larger team-based study. This proposed project and future research from this will contribute to improve the equity and quality of care and health and well-being of residents, caregivers and staff in long-term care homes.

CHILD-BRIGHT: Child Health Initiatives Limiting Disability — Brain Research Improving Growth and Health Trajectories – Phase 2

Health Research BC is providing match funds for Phase 2 of the Network, which is funded by the Canadian Institutes of Health Research’s (CIHR) Strategy for Patient-Oriented Research (SPOR) Networks in Chronic Disease.

Supported through CIHR’s Strategy for Patient-Oriented Research and 15 generous funding partners, CHILD-BRIGHT is a pan-Canadian patient-oriented research (POR) network that focuses on brighter futures for children with brain-based developmental disabilities (BDD) and their families.

Dr. Dan Goldowitz, Professor Emeritus of Medical Genetics at UBC and senior scientist at the Centre for Molecular Medicine and Therapeutics at the BC Children’s Hospital Research Institute, is one of CHILD-BRIGHT’s three co-PIs, along with Drs. Steven Miller at UBC, and national PI Annette Majnemer at McGill University.

Our national Network of 350 researchers, clinicians, decision-makers, youth and parents have co-created a novel research program based on priorities identified by patient-partners and other stakeholders that incorporates new technologies and interventions to advance health practice and policy. In our initial phase (2016-22), thirteen projects focused on early intervention that promotes brain/child development, strategies that support mental health of children/families, and service delivery redesign that addresses gaps in service.

A major focus for our Network is moving research into action through insight, inclusivity and methods grounded in implementation science (IS) and knowledge mobilization (KM). In Phase 2 (2022-26), we will accelerate the uptake and use of the knowledge generated in Phase 1 to enhance child health and family well-being within BC and across Canada. Our goal is to become a movement for change by moving patients and families into research teams, moving research into practice and policy, and ultimately moving children and families forward to brighter futures.

Dr. Goldowitz is co-leading CHILD-BRIGHT’s Training and Capacity-building Program with implementation scientist Dr. Celia Laur from the University of Toronto. In concert with his UBC team, they will engage with relevant groups including patients and families, trainees, and researchers to build a comprehensive training program that will enhance core competencies in POR, KM, IS, and EDI.

In addition, a core Phase 2 project spearheaded by Drs. Hal Siden and Tim Oberlander will receive funding support. “Pain and Irritability of Unknown Origin (PIUO): Implementing a Diagnostic Pain Pathway in Community Clinics” will translate the findings from Phase 1 into a readily available tool that can help community pediatricians systematically assess the potential root causes of pain and irritability in children with complex medical needs

Planning and designing a patient-centered measure for physician workload in the pediatric emergency department

Measuring the workload of pediatric emergency physicians is essential to help determine workforce needs, allocate resources to ensure timely care, assure patient safety, and diminish burnout. There are currently no widely accepted ways to measure pediatric emergency physician workload. Currently, staffing decisions are based on gestalt, availability, or average productivity measures that do not account for individual patient resource needs. This can lead to discrepancies in workload that affect both safety and efficiency and contribute to increased wait times and physician burnout. At a high level, a valid and reliable physician workload measure would help government agencies, universities, and hospital administrators identify and plan physician workforce needs and guide strategies for the training, recruitment, retention and allocation of the physician workforce. On a day-to-day and clinical level, this measure would allow for monitoring the workload of individual physicians in the emergency department (ED) and eventually, using machine learning (artificial intelligence) and linked healthcare data, could predict the workload for each patient that walks into the ED in order to assure a balanced, safe, and efficient assignment of patients. This grant will allow Canadian experts in pediatric emergency medicine, health services research, digital health, patient experience, and indigenous health to share knowledge and perspectives and establish a framework to derive and test a pediatric emergency physician workload measure in future planned research collaborations.

Dr. Quynh Doan is a clinician scientist in pediatric emergency medicine and health services research at the University of British Columbia. The multi-disciplinary team conducting this project has expertise in health services research, decision support systems, bioinformatics, implementation of research software projects, and clinical decision support.

End of Award Update – July 2024

Results

With our funding, we were able to gather local community member partners along with pediatric emergency medicine and digital health experts from across Canada for a productive three-day workshop. Over the course of the three days, we were able to develop a comprehensive list of patient care components that pediatric emergency physicians perform, as well as patient and environmental factors (modifiers) that can influence physician workload. We were also able to generate preliminary workload scores for each care component. This work completes phase one of our project, and we will now gather an even larger number of pediatric emergency physicians to verify the preliminary scores and assign a weight to each modifier in our second group of gatherings across the country.

Impact

Our team has been working on a manuscript that will soon be submitted for publication describing how we developed the SWAMPED score. We have also presented the project to clinicians across Canada and the Pacific Northwest; it received a very positive response at both presentations and audience members were interested in collaborating in future work. We will work with our collaborators to write our next grant together to do the later work for this project.

Additionally, having pediatric emergency medicine experts and community member partners share their experiences with giving and receiving care in the pediatric emergency department, respectively, allowed for each group to better understand the other in this context, while also contributing to the goals of our workshop. This will also have impacts on our future work as it has helped to strengthen collaborations that are key to continued progress and success.

Potential Influence

This novel physician workload measure will allow for future work using machine learning with linked healthcare data, developing systems that can forecast workload associated with individual pediatric emergency department patients and facilitate the most efficient and safe assignment of workload to providers. This will help anticipate future workforce requirements and guide resource allocation appropriately, while also improving patient care and reducing physician burnout.

Next Steps

We will now work on the validation phase of the SWAMPED project. This phase will see participating physicians complete online surveys to score different aspects of their workload based on the list of specific care components and modifiers developed during our initial workshop. The validation of SWAMPED will move us one step forward towards implementation, improving patient care, reducing physician burnout, and increasing the sustainability of the pediatric emergency medicine workforce.

Optimizing Virtual Health to Empower Caregivers: Setting an intersectional research agenda

This project builds from relationships in BC to develop a national network of virtual healthcare and caregiving researchers, practitioners, and decisionmakers to explore opportunities for collaboration. The project is led by Dr. Julia Smith, Assistant Professor in the Faculty of Health Sciences at Simon Fraser and lead for Health and Social Inequities team at the Pacific Institute on Pathogens, Pandemics and Society. Co-principal investigators include Lindsay Hedden, an Assistant Professor in FHS at SFU and Scientific Director of the BC SUPPORT Unit, and Andrew Sixsmith, a Professor in Gerontology and Director of the Science, Technology and Research (STAR) Institute at SFU. The team includes three trainees: Becky White (PhD student, Gerontology), Alice Murage (PhD Student, FHS) and Simran Purewal (MSc Student, FHS). Megan MacPherson the Regional Lead, Research and Knowledge Translation, Virtual Health at the Fraser Health Authority joins the team as a knowledge user.

In Canada, over 75% of healthcare is provided by unpaid, informal caregivers. Despite the essential role of caregivers, they are rarely recognized as part of the health workforce and receive little support. Caregiving is structured by racial and gender norms, as well as economic inequities, as the majority of caregivers are women, many of them racialized and low income. Caregivers’ responsibilities directly impact their social determinants of health, forcing them to give up paid work, education, and community engagement opportunities, while contributing to increased isolation and stress. The increasing use of virtual care can have both positive and negative effects on caregivers.

The goal of this project is to develop a research agenda focused on identifying structural inequities experienced by caregivers and virtual care service delivery solutions that empower caregivers to provide quality care while supporting their own well-being and reducing social, economic and health costs.
Research activities in BC include individual stakeholder consultations, an environmental scan and a workshop. Outputs from the above activities will be brought together to co-develop a participatory research agenda around developing virtual care solutions that empower caregivers.

End of Award Update – June 2024

Results

Results from our research indicate that little virtual health research or policy considers the unique role of family/friend caregivers in virtual health delivery – despite the fact 75% of healthcare in Canada is provided unpaid by family and friends. We found virtual health delivery can be empowering for caregivers, in terms of reducing time burdens and costs to care, but also creates challenges, as caregivers take on new roles around monitoring and communication. Concerns were raised about privacy and confidentiality, as well as access to virtual health from those who do not speak English as a first language. Both primary and secondary research confirmed that type of healthcare (for example monitoring versus complex diagnosis) and patient demographics (for example, adults versus children) greatly influenced the perceived benefits of virtual health.

These findings reflect those of our literature review (currently under review) and are summarized in our environmental scan here – https://pipps.cdn.prismic.io/pipps/Zj5UvUFLKBtrWyT7_VirtualHealthEnvironmentalScanMay2024.pdf

Impact

Our results have been shared directly, through consultations and lunch-and-learns with over 50 caregivers, clinicians, researchers’ and decision-makers in British Columbia. Through these discussions, as well as our outputs, we aim to inform the development of interventions that recognize and support the essential role of caregivers in virtual health delivery, which in turn will have positive impacts on health service delivery and patient wellbeing.

We have also shared our findings nationally and globally through academic papers and public facing outputs, such as in the Conversation (forthcoming).

Potential Influence

With this funding we have started a conversation about the essential role of caregivers in virtual health delivery. We will continue these conversations with our partners and decision-makers, drawing on the evidence generated through this project. While we aim to inform health care delivery in British Columbia, our publications share learnings relevant to the many other contexts which have also seen a rapid scale up of virtual health.

Next Steps

We have submitted one article (a literature review) to SSM- Health Systems and are currently drafting another (based on the consultations). We have an article about to be published in the Conversation as well as an environmental scan report (https://pipps.cdn.prismic.io/pipps/Zj5UvUFLKBtrWyT7_VirtualHealthEnvironmentalScanMay2024.pdf)

One of the students employed through this project will be sharing results at the Global Conference on Aging and Gerontology (https://www.agconf.org/) in August.

We have also applied for a CIHR Project Grant to continue this research.