2007-2008 IHSPR Rising Star Award Recipients
IHSPR is pleased to announce the inaugural 2008 IHSPR Rising Star Award recipients. Five students studying in the field of health services and policy research were recognized as Rising Stars and will receive the Rising Star Award ($1,000), a certificate of excellence, and the opportunity to present their research at the May 2008 Canadian Association for Health Services and Policy Research (CAHSPR) conference.The Rising Stars were selected by a review committee based on their demonstration of excellence in research and/or knowledge translation (KT), the innovation of their work, and the potential impact of their work within the field of health services and policy research. Congratulations to the first-ever IHSPR Rising Stars!
Katie Dainty
PhD student
Institute of Medical Sciences
University of Toronto
Knowledge Translation initiative: Using a multifaceted KT strategy to improve quality of care in community ICU's: a cluster randomized pragmatic trial
Katie received her MSc from the University of Western Ontario in 2001. While working in a large clinical research centre in London, her interest in knowledge translation (KT) was sparked and she began her PhD in Medical Science at the University of Toronto in September of 2006. Her thesis work pertains to the use of 'collaboratives' or 'networks' for KT and performance improvement in health care. She is also interested in furthering our understanding of the importance of implementation science as a key partner to health services research.
Katie's KT initiative focuses on improving quality of care in community intensive care units (ICUs) using a unique cluster randomized pragmatic trial approach. With approximately 1024 critical care beds in Ontario and no formal systematic way of improving quality and patient safety within the complex system, Katie's research and KT strategy has the potential to improve patient safety and quality, and increase resources available to Ontario's critical care system. It is also the first time that rigorous research methodology (cluster randomized design) has been applied to evaluate a complex quality improvement intervention, an important step forward in this type of research.
Katie's study aimed to answer whether "a multifaceted KT approach using innovative communication strategies increase the adoption of clinical best practices that are known to improve patient outcomes in the ICU." Her project was comprised of intensive care units in 15 community hospitals in Ontario. A primary objective was to link these otherwise independent hospitals using multifaceted interventions intended to increase the uptake of clinical best practices that are known to improve patient care. Katie's KT strategy bundled six interventions: 1) a summary of evidence and "core facts" pocket card, 2) a videoconference expert speaker series, 3) monthly network meetings, 4) reminder tools, 5) and monthly audit & feedback, locally tailored depending on the needs of the site. Additionally, units were able to share resources such as protocols and order sets through the network, which pooled resources and reduced duplication of effort for busy units.
While the final results of Katie's project are just being analyzed, the quantitative and qualitative interim results are noteworthy. Based on the success of this 2-year demonstration project, Katie reports that a province-wide best practices support program is currently being proposed for all ICU's in Ontario. The program will provide ongoing surveillance for evidence-based practices that, appropriately packaged and delivered, will further promote safety and quality in Ontario's critical care system.
Katie intends to complete her PhD program in June of 2010 and will continue her work at the Centre for Health Services Sciences at Sunnybrook Health Sciences Centre in a Primary Scientist role. She also hopes to find an opportunity to join the faculty at the University of Toronto. Overall, Katie aspires to have her work actively inform tangible improvement efforts in the Canadian healthcare system and to teach others about the importance of evaluating what we do everyday, to learn more about how we can improve our health system for staff & patients.
To learn more about Katie's research and KT initiative, please email her at Katie.Dainty@sunnybrook.ca.
Randy Fransoo
Researcher, MCHP, and Assistant Professor, Community Health Sciences
(Completed PhD in October 2007)
University of Manitoba
Knowledge Translation Initiative: Partnership: the key to KT success
Randy received his PhD from the University of Manitoba in October 2007. His main research interests are in population health and health service use, child health and development, and epidemiology of heart health and cardiac care.
The knowledge translation work for which Randy has been recognized as a Rising Star centres on the important role of partnerships in research, based on two projects.
The first was a CPHI-funded project on "Inequalities in Child Health." The project used a population-based approach to assess children's performance in school, and found that the social gradient in educational outcomes was much steeper than previously reported. This created a major KT challenge - to spread the word without coming across as 'another bad news report', and avoid providing results that would have allowed for victim blaming, or unproductive comparisons among schools. Randy and his colleagues accomplished these goals through consultations with representatives from government, the school system, and other stakeholders. This work was related to his PhD dissertation "How children's health status at birth and through childhood affects progress and performance in school: a population-based study."
What impact did Randy's KT initiatives have on local policy and practice? The Manitoba Department of Education has responded in several ways: the Community Schools Partnership Initiative was created to provide additional funding and supports to schools serving high need groups; initiatives to improve student engagement in the middle years have been developed; and currently, a program to provide additional resources to schools in low-income areas is in development. In addition, one of Randy's early presentations at a Social Planning Council 'Think Tank' motivated the development of a community-led summer enrichment program for inner-city children, which started in two schools and now operates in six.
The second KT initiative relates to Randy's work with the Need To Know team, which he now co-directs with Dr. Patricia Martens. The Need To Know team was initially a 5-year CIHR-funded project involving health services researchers, high-level managers from each Regional Health Authority, and provincial planners from Manitoba Health. The work of this team has fundamentally transformed how researchers interact with decision makers in co-developing and applying results of health services research. This experience has fundamentally shaped Randy's approach to research, to involve end-users from the start of a project to foster two-way capacity building and ensure new knowledge is relevant for current program and policy issues.
Randy continues to work as a researcher at MCHP, and Assistant Professor in Community Health Sciences at the University of Manitoba.
To learn more about Randy's work, please email him at Randy_Fransoo@cpe.umanitoba.ca.
Gillian Hanley
PhD student
Health Care and Epidemiology
University of British Columbia
Research article: Assessing vertical equity in pharmaceutical financing under income-based prescription drug coverage in British Columbia
Gillian received her MA in Economics with a concentration in Health from McMaster University in 2004. Following graduation she worked as Project Manager with Dr. Steve Morgan's program in pharmaceutical policy at the UBC Centre for Health Services and Policy Research. Here, Gillian developed a passion for empirical health services research in the area of pharmaceuticals "because they play a fascinating role in both the economy and population health." This passion led her to pursue a doctorate degree in Health Care and Epidemiology at UBC. Gillian's thesis work investigates equity in access to medicines both before and after the implementation of income-based pharmacare in British Columbia (BC). She would like to determine specifically whether income-based catastrophic drug coverage results in barriers to accessing essential medicines for some members of the population.
The paper for which Gillian received the IHSPR Rising Star Award, "Distributional consequences of the transition from age-based to income-based prescription drug coverage in British Columbia, Canada," relates to her thesis work and was published in the January 11, 2008 online edition of Health Economics. "The study", says Gillian "examines the extent to which households with higher incomes contribute a larger share of income towards pharmaceutical financing than those with low incomes both before and after the implementation of income-based pharmacare (Fair Pharmacare) in BC in May 2003."
When the province of BC shifted to financing prescriptions on the basis of income rather than age, Gillian and her co-authors "found that the new system was more progressive, largely due to removing subsidies from high-income seniors." She notes "it's a half Robin Hood story, because while it took from the rich, it does not appear to have given to the poor". While the new income-based pharmacare program appears to be more progressive than the previous age-based program, it does not redistribute to low-income seniors because of other policy changes that occurred around the same time that Fair Pharmacare was introduced, such as provincial program cuts and changes in taxation.
Gillian's analysis creatively uses administrative datasets and takes advantage of a "natural experiment" to provide evidence not only for BC, but for the rest of Canada and even the world, as they struggle to find policies that slow pharmaceutical expenditure growth while preserving equity of access to health care. Her exploration of the equity consequences of income-based pharmaceutical strategies has opened the door for further analysis. "I hypothesize that there was a group of winners and a group of losers that this study didn't really show," says Gillian. "It's quite possible that lower and middle income people who rely heavily on prescriptions really lost out in 2003." Those outcomes will receive further attention, as part of Gillian's doctoral thesis.
Gillian aims to complete her PhD in 2011 and hopes to pursue an academic career in health services and policy research.
To learn more about Gillian's study, please email her at ghanley@chspr.ubc.ca or visit the Centre for Health Services and Policy Research.
Paul Kurdyak
PhD Student
Health Policy, Management and Evaluation
University of Toronto
Research article: The effect of antidepressant warnings on prescribing trends in Ontario, Canada
Paul Kurdyak is a staff psychiatrist at the Centre for Addiction and Mental Health and is pursuing a PhD in clinical epidemiology in the Department of Health Policy, Management and Evaluation at the University of Toronto. In addition to Paul's thesis interests (where he is using a population-based cohort of acute myocardial infarction survivors to determine the impact of depression on mortality and health services utilization), he is also interested in studying the impact of policy on health services and drug utilization. Paul recognizes that "health care policies have both intended and unintended effects" and that "the unintended effects are often difficult to predict." He is interested in using existing administrative data to measure unintended consequences of health care policies so that lessons can be learned about successful policy implementation.
The paper for which Paul received the IHSPR Rising Star Award, "The effect of antidepressant warnings on prescribing trends in Ontario, Canada" relates to his interest in studying the indented and unintended effect(s) of policy. In Paul's paper, published in the April 2007 issue of the American Journal of Public Health, he and his co-authors assess the impact of regulatory guidelines (i.e., antidepressant warnings) on prescribing behaviors. Specifically, using population-based utilisation data and the natural experiment of a discrete occurrence of a drug warning, Paul's study examines the impact of antidepressant warnings issued by regulatory agencies in three countries (the UK, the US and Canada) on physician prescribing trends in different age categories. The antidepressant warnings were issued because of concern about possible association between antidepressant use and increased risk of suicide, particularly in adolescents, and the authors hypothesized that the warnings would result in the immediate reduction of antidepressant prescriptions.
Interestingly, Paul's study reveals that while the UK warning had an immediate and sustained effect on new paroxetine prescriptions (a type of antidepressant drug) for individuals less than 19 years of age, warnings in the US and Canada had no effect in any age or antidepressant category.
Paul suspects that his findings might be explained by the fact that the UK warning was issued for a particular drug (paroxetine) and for a defined group of patients (i.e., it was targeted and specific), which meant that UK physicians could avoid prescribing the specific drug paroxetine but still treat adolescent depression with other antidepressants. In Canada and the US, however, the warning was not specific to a particular drug or group of patients but rather to antidepressants as a class (i.e., it was general), which left physicians without any antidepressant treatment options and caused them to simply disregard the warning altogether.
Paul reflects that his study findings suggest that "drug warnings disseminated by regulatory agencies are effective and actionable when they are specific and provide clinicians with treatment options, particularly when the evidence for the adverse drug effect is equivocal." He believes that his findings highlight both strengths and weaknesses of regulatory agency warnings as a tool for knowledge translation.
Paul aims to complete his PhD in 2008 and will continue to both examine the relationships between depression and chronic medical illnesses and the impact of mental health care policies on utilisation of health services. To learn more about Paul's research, please email him at Paul_Kurdyak@camh.net.
Sylvia Reitmanova
PhD student
Community Health & Humanities
Memorial University of Newfoundland
Knowledge Translation initiative: Mental Health Needs of St. John's Immigrants: Knowledge Transfer Initiative
Sylvia received her MD in 1997 in Bratislava (Slovakia) and her MSc at Memorial University of Newfoundland in 2006. Her doctoral work examines media discourses of immigrant tuberculosis and their relevance to current public health management policies relating to tuberculosis in Canada.
The research on which Sylvia focused her knowledge translation (KT) initiatives examined determinants of St. John's immigrants' mental health and well-being and the barriers they face accessing local mental health services. Sylvia comments that "developing accessible support mechanisms that are responsive to needs of immigrants is essential to mitigating the negative effects of immigration-related difficulties … that make immigrants vulnerable to mental illness." Sylvia received the IHSPR Rising Star Award for her work on increasing policy maker's awareness of local immigrant's mental health-concerning needs and the barriers they face in accessing health services in Newfoundland and Labrador.
Sylvia took a multifaceted approach to her KT initiatives: she started with an environmental scan of the available information and then engaged in linkage activities with relevant stakeholders (i.e., policy makers, mental health service providers, immigrants, etc) to ascertain their priority issues and research questions. These stakeholders, Sylvia notes, "suggested several key questions pertinent to issues of immigrant health and proposed ways for me to disseminate my research findings." When Sylvia completed her study she disseminated her findings to those on the ground through multiple mechanisms. She targeted policy makers (to affect policy), providers and clinicians (to affect care delivery), researchers (to advance this body of literature), and the public (to increase awareness). During Mental Health Awareness Week, she presented her work to mental health and immigration policy makers and based on this she also prepared two reports. The report on social determinants of immigrants' well-being was delivered to the provincial government's Immigration Office. The report for mental health decision makers, organizations and services providers was made available via posting on the Newfoundland and Labrador Centre for Applied Health Research website. Sylvia also made presentations to mental health service decision makers and providers at a local hospital. She plans to take her dissemination initiatives one step further by publishing them in local immigrant newspapers and mailing lists and by offering an in-kind workshop to a clinic team that provides health services to immigrants. For the academic community, her research was published in the Journal of Immigrant and Minority Health and she has made five presentations at local, national and international conferences.
What impact did Sylvia's KT initiatives have on local policy and practice? Policy makers in Newfoundland and Labrador have since implemented several recommendations for developing more socio-culturally responsive services that take into consideration the unique health-concerning needs of immigrants. Additionally, her results were used in the development of a new Immigration Strategy released by the provincial government in March 2007, and the Canadian Mental Health Association released a mental health brochure that addressed some of the mental health information needs of the local immigrant community that Sylvia identified in her research.
Sylvia aims to complete her PhD in 2009 and to do more research in the issues pertinent to transcultural health - in particular, the determinants of immigrant health, immigrants' health needs, inequalities and vulnerabilities, their barriers to primary care, as well as the development of socio-culturally appropriate health policies, education, and training. To learn more about Sylvia's research and KT initiatives, please contact her at sreitman@mun.ca.