Title: Improving End-of-Life Care in the Community (funded)
Research Team: Doug Manuel, Deborah Sattler, Fred Burge, Susan Bronskill, Christopher Clinger, Beverley Lawson, Jose Pereira, Peter Tanuseputri, Robin Urquhart
Health care provided to the dying can help improve the quality of remaining life. A large proportion of dying Canadians, unfortunately, do not get optimal end-of-life care. Part of the challenge is the difficulty of identifying where people are in their death trajectory. We are currently creating tools to map out this trajectory for people in the community, using data collected for those who are requesting home care or long-term care. In this grant, we propose to pilot these tools on case managers who are doing the assessments, and also on patients and their caregivers. Our tools will provide a report on how close patients are to death (a range, predicted based on previous observations), and will provide a link to resources (e.g., advance care planning tools and available community supports) that will help their journey. Following our pilot, we will conduct focus groups to determine how we can make the tools more useful and acceptable. We will then modify our tools, and prepare for a larger roll-out in the Windsor-Essex County population that has formed a multi-sectorial coalition that aims to improve the care of those who are frail and nearing the end-of-life. Our goal is to create and implement a scalable tool that will help patients, caregivers, and health care providers anticipate death, so that integrated and optimal care can be provided.
Title: Characterizing high system use across the primary-tertiary care continuum: parallel analyses of select Canadian health datasets (funded)
Research Team: Tyler Williamson, Ewan Affleck, Kris Aubrey-Bassler, Gabriel Fabreau, Kerry McBrien, Nandini Natarajan, Paul Ronskey, Alexander Singer, Sabrina Wong
In Canada, health care expenditures continue to rise unabated. This has left policy makers struggling to develop effective strategies aimed at reducing costs while at the same time improving patient care. A compelling approach to bend the cost curve has been to focus on the small number of patients who account for the majority of health care spending. It has been determined that as much as half or more of health care expenditures are accounted for by 5% of the population. Significant gaps in our understanding of these high-use patients remain, including how they engage with the health care system, and whether there are similarities and differences between the characteristics of high use patients in primary and hospital-based settings. Closing these knowledge gaps has been identified as a top research priority both provincially and nationally. This project aims to address these important issues by leveraging data from electronic medical records and multiple administrative data sources from across Canada. Using these data, the similarities and differences in the characteristics of high use patients across different health care settings will be explored. This work will provide essential foundational information about high users across the health care continuum and will promote future inter-provincial collaborative research and health policy development. Ultimately the goal is to inform innovative clinical strategies and policies to improve quality of care and health outcomes for patients with high system use.
Title: Playing Telephone: Medication management and integrated electronic health records (funded)
Research Team: Kelly Grindrod, Catherine Burns, Samina Abidi, MJ Dogba
The objective of this project is to analyze the current state of shared electronic health information across patients, primary clinics and pharmacies, including types of information exchanged, best practices and tools that support interprofessional shared medication decision-making. Medication management will be observed in four sites: Alberta, Ontario, Quebec & Nova Scotia and collect data on how different stakeholders participate in the medication review process, the outputs of the reviews, how medications are recommended and how patients make decisions around taking medications. Through structured interviews, we will inquire about how participants identify potential and existing medication problems and work to solve the problem. The ultimate beneficiaries are patients who are transiting the healthcare system and clinicians who care for them. There is a real opportunity to implement the results from this study into future electronic health record software with our partner the Telus Health and have a significant impact on Canadian healthcare.