Progress on Funded Quick Strike, Knowledge Synthesis, and Comparative Program and Policy Analysis SPOR Grants in BC

Quick Strikes

Validation of Administrative and Primary Care Electronic Medical Record Derived Frailty Algorithms

Provinces: BC, AB, MB
Investigators include: Sabrina Wong (BC), Tyler Williamson (AB), Alan Katz (MB)

Frailty is a medical syndrome with numerous causes, characterized by reduced strength, endurance and physiological function, which results in increased vulnerability to functional decline, dependence and/or death.

Objectives

  1. Identify administrative and electronic medical record data derived algorithms of frailty in community-dwelling seniors (aged 65 and older);
  2. Conduct content, face, and predictive validation of the administrative and electronic medical record frailty algorithms by engaging primary care clinicians and patients; and
  3. Identify natural ranges of frailty associated with differential risks of experiencing a hospital-related event.

Activities to date
The administrative data algorithm is almost complete, although gaining permission to use the administrative data and conducting data linkage in BC was more complex than anticipated. The team is in the process of linking administrative and clinical data, and of having sentinel physicians from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) participate in verifying some of the patients identified as frail. They anticipate the work with the sentinels will take place in the next two months and the electronic medical record algorithm will be developed in the next four months.

The team presented a poster at the Canadian Association of Health Services and Policy Research conference in May and plan to present the finished work at the North American Primary Care Research Group Conference in November. The team is also looking for a patient willing to provide feedback.

Comparative Analysis of Centralized Waiting Lists for Patients Without a Primary Care Provider Implemented in Six Canadian Provinces

Provinces: BC, MB, ON, QC, NB, PEI
Investigators include: Mylaine Breton (QC), Sabrina Wong (BC), Jason Sutherland (BC), Michael Green (ON), Sara Kreindler (MB), Jalila Jbilou (NB), Valorie A. Crooks (BC), Jay Shaw (ON), Astrid Brousselle (QC)

In Canada, 15% of the population is unattached (i.e. does not have a primary care provider). In an effort to improve access to primary care, six provinces have implemented centralized waiting lists to help connect patients and providers.

Objective
To compare the different models of centralized waiting lists for unattached patients implemented in six provinces of Canada to each other and to available scientific knowledge to make recommendations on ways to improve their design in an effort to increase attachment of patients to a primary care provider.

Activities to date
The team used a three step logic analysis approach:

  1. Build logic models describing each centralized waiting list (34 interviews with key stakeholders, grey literature, and six validation meetings);
  2. Develop a conceptual framework based on key characteristics of centralized waiting lists for unattached patients and factors influencing their implementation (realist review on approaches to managing centralized waiting lists and on incentives to providers to promote attachment);
  3. Compare the logic models to the conceptual framework to make recommendations to improve centralized waiting lists in different provinces (face-to-face symposium with key stakeholders and researchers from the six provinces; logic analysis).

The team has finished building the logic models (step 1) and are currently finishing the realist reviews (step 2). Preliminary findings indicate large variations between provinces in implementation and processes. Stakeholders in all provinces reported difficulties in attaching complex/vulnerable patients (e.g. those with mental health issues). Centralized waiting lists across Canada were seen somewhat fragile as they are highly dependent on the supply of primary care providers and providers’ capacity to attach new patients. Over the next few months, the team will finalize the conceptual framework (realist reviews) and compare it to the provinces’ logic models to identify promising strategies for improvement.


Knowledge Synthesis Grants

Building Wellness and Resilience in Multi-Generational Indigenous Households: A Scoping Review

Provinces: BC, AB, SK, ON
Investigators include: Cheryl Currie (AB), Linda ManyGuns (AB), Leslie Varley (BC), Cheryl Ward (BC), Anne Marshall (BC)

Working with a data librarian, an academic search yielded 1,200 article for possible inclusion in the scoping review. A team of four reviewers is going through the articles (two independent reviewers per article). The Lethbridge team has met once a week since January to discuss the articles selected, the data to be extracted from each article, and any discrepancies in article selection.

Early in 2017, once 50% of the reviews were complete (i.e., 600 articles reviewed), the team held a full cross-provincial meeting by teleconference to review the findings, make any adjustments needed to the search protocol, and to discuss strategy for the grey literature search.
As of May, the team has completed review of 1,000 articles, and the grey literature search is well underway, which includes calls to agencies that are running programs related to the research questions, but that have not yet been reported on in the form of a publication.

In June, the team will meet with First Nations community partners to discuss scoping review findings to date, as colleagues are eager to implement programs based on the findings of the review. In September the team will have a full cross provincial team meeting to review the full set of programs selected for the review through both the academic and grey literature searches.

In November, a full team meeting will be held in person in Lethbridge. This face-to-face meeting will extend beyond the cross-provincial project team to include relevant stakeholders and patient representatives. Findings will be shared and the day will be spent discussing the potential applications of the results for health care providers serving rural and urban Indigenous populations.

Dimensions of Quality for Mobile Applications in Chronic Disease Management

Provinces: BC, ON, QC
Investigators include: James Shaw (ON), Edward Brown, Pierre Fremont (QC), Scott Hofer (BC), Payal Agarwal (ON), Elizabeth Borycki (BC), André Kushniruk (BC), Holly Witteman (QC)

Mobile apps have the potential to increase access to education, tools for monitoring and overall self-efficacy for patients with chronic conditions. However, what defines a quality virtual care intervention, and, in particular, how to know if and when it should be used in patient care is unknown. The team is conducting a scoping review of App Store reviews of apps to summarize current methods for identifying high quality patient facing apps for chronic disease management. After the team identifies what criteria are being used to evaluate apps, they will compare them against criteria from user experience design and from evidence-based principles to build guidance for real-life, real-time evaluation of what makes a good chronic disease management app.


Comparative Program and Policy Analysis Grants

The Impacts of Being Formally Enroled with a GP on Continuity and Integration of Care: Evidence from a Comparison of Quebec and British Columbia

Provinces: BC, QC
Investigators include: Erin Strumpf (QC), France Legare Lavalle (QC), Antoine Groulx (QC), Christine Loignon (QC), Kim McGrail (BC), Laurie Goldsmith (BC), Ruth Lavergne (BC), Catherine Hudon (QC), Marie-Thérèse Lussier (QC), Claude Richard (QC)

Since January 2017, the four co-principal investigators have participated in monthly teleconference calls. These calls provide opportunities for shared decision making among research team members, who are from different provinces (QC and BC) and different research disciplines. The team has developed the recruitment and interview materials for patients and physicians and has submitted the application for ethics approval to the McGill University Institutional Review Board. The research team has also recruited, over the last six months, four patient partners (two in each province). These patient partners will participate as team members on advisory and executive committees. The research team is currently working on the organization of the first advisory committee meeting. This meeting will be held in Montreal on July 6 and will bring together patients, clinicians, researchers and decision makers from both provinces, to inform the direction of the research project by refining the questions and fostering patient and physician recruitment.

Integrating Paramedics into Primary Care to Optimize Patient Time in the Community at End of Life

Provinces: BC, NS
Investigators include: Alix Carter (NS), Fred Burge (NS), William Dick (NS), Andrew Travers (NS), Judah Goldstein (NS), Bev Lawson (NS), Michelle Harrison (NS), Sabrina Wong (BC), Jennifer Kryworuchko (BC), Kim McGrail (BC), Dug Andrusiek (NS)

The research team is currently working on the detailed analysis plan and data access documentation for the project. The research team members in both provinces (BC and NS) have been working closely together to ensure that the same data is requested in the two provinces, despite different provincial databases. This is especially important for the provincial emergency health services data, since it is a less familiar dataset. Detailed analysis plan building and the corresponding data access documentation is a crucial step for the research project and is being tackled systematically. The team anticipates having data access request documentation ready for the relevant data stewards by the end of June.

Policies and Program Innovations that Connect Primary Health Care to Social, Community and Public Health Services in Canada: A Comparative Policy Analysis

Provinces: BC, AB, QC, NB, NS, PEI
Investigators include: Jeannie Haggerty (QC), Amélie Quésnel-Vallée (QC), Yves Couturier (QC), Réjean Hébert (QC), Leanne Currie (BC), Nelly Oelke (BC), Jason Sutherland (BC), Shelley Doucet (NB), Bill Montelpare (PEI), Tara Stewart (MB), Robin Urquhart (NS), Cathie Scott (AB)

The research team is currently conducting a nominal group process with all team members (researchers and knowledge-users) on each of the focus areas (community dwelling older adults with functional decline and children’s services) to:

  1. Identify services and categories of services that need to be connected;
  2. Identify a list of 10-15 services that can be agreed upon by team members.

Once this has been completed, the team will define the categories of services and set priorities among team members.


Back to BC-PHCRN June 2017 Update