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)
Funding amount: $114,650
Year funded: 2015

Objectives
This study uses a cohort approach to examine community-dwelling seniors aged 65 years and older in BC, Alberta and Manitoba in order to identify administrative and electronic medical record (EMR) data-derived algorithms of frailty; conduct validation of the data by engaging primary care clinicians and patients; and identify the association between frailty and experiencing a hospital-related event. The researchers are using aggregated administrative data from 2011-2015, and current EMR data from clinicians using the Clinical Frailty Scale to identify frailty in their patients.

Activities to date
In the administrative data, the researchers have used three rules in patients older than 65 to identify frailty: 1) Resident in a long-term care or assisted-living facility; 2) terminally ill; and 3) at least two indices from the Edmonton Frail scale (cognitive impairment, incontinence etc.). Patients who met one or more of these identification rules had increased healthcare use and costs, as well as longer stays in hospital and higher numbers of acute hospitalizations compared to non-frail patients. Using these data and rules, the research team identified approximately 7.5% and 8.5% of the BC and Manitoba populations, respectively, who could be considered frail.

Frailty rates using the EMR data have been determined using machine learning algorithms. To date, 52 clinicians completed 1,025 patient assessments using the Clinical Frailty Scale. Fourteen percent (n=150) of these patients were considered frail. Using machine learning, the research team created an algorithm that included data from the Clinical Frailty Scale assessment as well as a number of other features from various EMR tables (billing, disease case indicators etc.).

The team’s next steps are to examine whether those identified as frail in the EMR data are also identified as frail in the administrative data.

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

Provinces: BC, MB, ON, QC, NB, PE, NS
Investigators include: Mylaine Breton (QC), Sabrina Wong (BC), Jason Sutherland (BC)
Funding amount: $95,110
Year funded: 2015

Objectives
The main objective of this study is to analyze the centralized waiting lists implemented in seven Canadian provinces and to identify promising characteristics to promote attachment of complex patients to primary care providers. Ultimately, the researchers intend to make recommendations on ways to improve the design of centralized waiting lists.

The project is a logic analysis: a theory-based evaluation that is conducted in three steps: 1) build logic models of the interventions, 2) develop a conceptual framework based on scientific knowledge and 3) compare the logic models to the conceptual framework.

Activities to date
The project is almost complete. The researchers have created a video targeted to non-academic audiences to share the project’s preliminary findings.

The research team has also been working on a number of papers. One of these papers has been revised and will be re-submitted to Healthcare Policy/Politiques Santé. A second paper is currently being revised and will be submitted soon. The final paper will be written once the first two have been submitted. The team has also submitted a presentation proposal for the CAHSPR conference in Montreal in May 2018.

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Knowledge Synthesis

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

Provinces: BC, AB, SK
Investigators include: Cheryl Currie (AB), Leslie Varley (BC), Cheryl Ward (BC), Anne Marshall (BC)
Funding amount: $25,000
Year funded: 2016

Objectives
The purpose of this scoping review was to map integrated service delivery models and strategies internationally, so that agencies have information they can use to support Indigenous households struggling with psychological trauma. Academic and grey literature was examined as part of this review.

Activities to date
The scoping review is now complete. The research team searched several thousand articles, and documented 76 international models that met the team’s search criteria. The results were disseminated via a meeting in Lethbridge, Alberta that included stakeholders, clinicians, academics and policy-makers from four provinces.

The research team collaborated with a First Nations community, Kainai, for this project. After the research was complete, Kainai partnered with two of the research team’s co-investigators to launch one of the integrated service delivery models found in the scoping review to Kainai Nation itself, in the departments of social services and health services. The grant for that project is currently being written as the next step on this program of research, inspired by this first CIHR scoping review grant.

Dimensions of Quality for Mobile Applications in Chronic Disease Management: A Review of Systematic Reviews

Provinces: BC, ON, QC
Investigators include: James Shaw (ON), Elizabeth Borycki (BC), Scott Hofer (BC), André Kushniruk (BC)
Funding amount: $25,000
Year funded: 2016

Objectives
The objective of this project is to evaluate mobile applications for chronic disease management based on pre-defined lists of quality criteria that can be applied in very short timeframes. The researchers will review the literature assessing mobile applications via reviews of application function for the purpose of addressing the following research question: What criteria of quality are used to assess mobile applications for the support of chronic disease management in studies that review application quality but not clinical effectiveness?

Activities to date
This study has progressed well throughout the past 12 months, including achieving the following milestones:

• Assembling the research team for three teleconference-based team meetings
• Finalizing the methodology as scoping review
• After several iterations with a professional librarian, the search has been executed in three databases
• Data screening methods were finalized and titles and abstracts were screened
• Data extraction form was finalized and data was extracted
• Data summary strategy was finalized and data is currently being summarized for analysis

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Comparative Program and Policy Analysis

The Impacts of Being Formally Enrolled 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), Kim McGrail (BC), Laurie Goldsmith (BC), Ruth Lavergne (BC)
Funding amount: $124,974
Year funded: 2016

Objectives
Some Canadian provinces have included patient enrolment with a general practitioner (GP) as a foundation of their efforts to make primary health care more accessible, more continuous, and of higher quality. The enrolment policies in Quebec and British Columbia (BC) both seek to increase patient attachment to primary care providers, but pursue this goal in different ways.

This project will compare Quebec and BC to help understand how enrollment with a GP affects the relationship between the patient and their doctor, and whether it improves or decreases the quality and continuity of care. The research team is also looking to determine if enrolling with a GP benefits some patients more than others.

Activities to date
The research team has begun securing stakeholders by engaging with four patient partners (two in each province) and establishing an Advisory Committee. The team has completed the qualitative recruitment materials for physicians and patients, as well as adapted the interview guides to consider stakeholders’ comments. The interviews have begun in Quebec, and the BC team will use the learnings garnered from Quebec to refine its approach.

The research team has begun extracting administrative data in both provinces, and is brainstorming ways to measure concepts of enrollment, attachment and continuity. Further, an executive committee meeting has been planned for April 24 in Vancouver that will facilitate a forum to discuss preliminary interview results.

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

Provinces: BC, NS
Investigators include: Alix Carter (NS), Sabrina Wong (BC), Jennifer Kryworuchko (BC), Kim McGrail (BC)
Funding amount: $125,000
Year funded: 2016

Objectives
The province of Nova Scotia has implemented a program designed to align palliative patients’ goals of care with paramedic protocols so that paramedics can respond effectively to urgent and unscheduled requests for palliative care. This initiative is called the Paramedics Providing Palliative Care at Home Program. The objective of this study is to compare Nova Scotia, a province with a programmatic intervention in primary health care delivery, with British Columbia, a province without this intervention.

Activities to date
This comparative program analysis study has obtained ethics approval, and the data elements and mapping have been completed. Planning is also underway to hold deliberative dialogue sessions in March 2018 to discuss the spread of this initiative to other jurisdictions.

The researchers are currently in the process of applying for a data access to facilitate data collection. In Nova Scotia, this includes three separate requests: the first to the Nova Scotia Department of Health and Wellness; the second to Nova Scotia Vital Statistics; and the third to the Nova Scotia Emergency Health System.

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, PE
Investigators include: Jeannie Haggerty (QC), Leanne Currie (BC), Nelly Oelke (BC), Jason Sutherland (BC), Anne Junker (BC), Victoria Schuckel (BC)
Funding amount: $114,856
Year funded: 2016

Objectives
This study examines policies and programs that aim to connect services or programs in primary health care (social services, public health, community supports, and primary care) to one another or to primary care to ensure continuity and integration of care, particularly for patients with complex care needs. For this study, the researchers targeted two patient populations groups: a) children and youth (0-25 of age) with high functional needs and b) community dwelling older adults experiencing functional decline.

Activities to date
The research team initiated the project work by developing an online platform to share documents, communicate with each other, and work collaboratively across their eight jurisdictions. This platform helped the team launch their macro policy and innovative programs scans component, which enabled them to learn about the policy structure of health governance in each province, and about any innovations across jurisdictions. The team is currently setting up interviews with health officials in each jurisdiction to aid in validating and expanding on the information gathered.

The research team has also submitted two abstracts to the upcoming CAHSPR conference in Montreal in May 2018. In addition, the team has organized a face-to-face meeting at CAHSPR so the researchers can meet share knowledge and work to address any issues.

Integrating End of Life Care to Help People Stay in the Community: The Essentials for Success

Provinces: NS, BC
Investigators Include: Grace Warner (NS); and Barb Pesut (BC)
Funding amount: $11,250
Year funded: 2016

Objectives
The objective of this realist review was to collaborate with family caregivers and health-system knowledge users to synthesize the literature on how case management can connect patients and their family caregivers nearing end-of-life to critical informal and formal community-based services/supports, all with the purpose of improving the delivery of community based palliative care.

Activities to date
The research team has completed its review of the literature identified in its initial search and included 161/2389 articles. The team is now focusing on creating intervention theories and associated recommendations.

Based on this literature review, the research team has determined the following:

• Family are the critical community support and patients and families need to plan for eventualities through advance care planning;
• The key is to assess patient/family needs and to have them identify what they feel are critical community-based services and supports; and
• Supports/services need to be tailored to the needs of patients/families, so what is critical will vary depending on their needs.

The researchers continue to evaluate the literature as they respond to other research questions.

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Back to BC-PHCRN March 2018 Update