INTRODUCTION
Below are brief summaries of selected primary health care studies led by Dr. Marshall as a Principal, or Co-Principal, Investigator. Please revisit this page for latest updates to these and future studies.
Thank you for your interest!
Thank you for your interest!
CUP Study
Title: The CUP Study: Comparative analysis of centralized waitlist effectiveness, policies, and innovations for Connecting Unattached Patients to primary care providers
Funding Agency: Canadian Institute of Health Research
Date: October 2021 - September 2025
Award: Project Grant
Amount: $592,876 (Canadian dollar)
Investigators: Marshall EG (Nominated Principal Investigator), Breton M (Principal Investigator), Green M (Principal Investigator), Andrew MK (Co-investigator), Ashcroft R (Co-investigator), Bayoumi I (Co-investigator), Burge F (Co-investigator), Correa Woodrow A (Co-investigator), Dahrouge S (Co-investigator), Duhoux A (Co-investigator), Edwards L (Co-investigator), Gibson RJ (Co-investigator), Kiran T (Co-investigator), Lawson B (Co-investigator), MacKenzie A (Co-investigator), Martin-Misener R (Co-investigator), Mathews M (Co-investigator), McPherson C (Co-investigator), Peddle S (Co-investigator), Ryan Carson S (Co-investigator), Sampalli T (Co-investigator), Wong S (Co-investigator), Bell K (Collaborator), Dube F (Collaborator), Grise H (Collaborator), Weld Viscount P (Collaborator), Yampolsky R (Collaborator)
DESCRIPTION:
Patients who have access to a primary health care (PHC) provider (family physician or nurse practitioner) benefit from better care coordination, chronic disease management and continuity of care, receive more preventative care, use emergency services less frequently and have better health outcomes. However, 15% of Canadians do not have a regular PHC provider and are classified as “unattached”.
Seven Canadian provinces implemented centralized waitlists (CWLs) to coordinate linking unattached
patients to a PHC provider. These are a new phenomenon in PHC and remain under-evaluated. It is
unknown how well CWLs attach patients to PHC providers, and moreover, which component attributes and processes best facilitate CWL success.
A previous study by our team described the components of CWLs in Canada; this proposed study will assess their effectiveness. Effectiveness is defined by the time to attachment of an unattached patient on the CWL to a PHC provider. We will take a mixed-methods approach to understanding the complex issue of CWLs in PHC.
By using CWL data linked to administrative data in provinces with diverse approaches to CWLs, we will determine their comparative effectiveness attaching patients to PHC providers across Ontario, Quebec and Nova Scotia, and provider and patient characteristics. Further, by incorporating qualitative methods that will capture and delineate the contextual factors that influence patient attachment, we can open the “black box” of CWL effectiveness to determine the components, processes, and environments that promote their success.
Funding Agency: Canadian Institute of Health Research
Date: October 2021 - September 2025
Award: Project Grant
Amount: $592,876 (Canadian dollar)
Investigators: Marshall EG (Nominated Principal Investigator), Breton M (Principal Investigator), Green M (Principal Investigator), Andrew MK (Co-investigator), Ashcroft R (Co-investigator), Bayoumi I (Co-investigator), Burge F (Co-investigator), Correa Woodrow A (Co-investigator), Dahrouge S (Co-investigator), Duhoux A (Co-investigator), Edwards L (Co-investigator), Gibson RJ (Co-investigator), Kiran T (Co-investigator), Lawson B (Co-investigator), MacKenzie A (Co-investigator), Martin-Misener R (Co-investigator), Mathews M (Co-investigator), McPherson C (Co-investigator), Peddle S (Co-investigator), Ryan Carson S (Co-investigator), Sampalli T (Co-investigator), Wong S (Co-investigator), Bell K (Collaborator), Dube F (Collaborator), Grise H (Collaborator), Weld Viscount P (Collaborator), Yampolsky R (Collaborator)
DESCRIPTION:
Patients who have access to a primary health care (PHC) provider (family physician or nurse practitioner) benefit from better care coordination, chronic disease management and continuity of care, receive more preventative care, use emergency services less frequently and have better health outcomes. However, 15% of Canadians do not have a regular PHC provider and are classified as “unattached”.
Seven Canadian provinces implemented centralized waitlists (CWLs) to coordinate linking unattached
patients to a PHC provider. These are a new phenomenon in PHC and remain under-evaluated. It is
unknown how well CWLs attach patients to PHC providers, and moreover, which component attributes and processes best facilitate CWL success.
A previous study by our team described the components of CWLs in Canada; this proposed study will assess their effectiveness. Effectiveness is defined by the time to attachment of an unattached patient on the CWL to a PHC provider. We will take a mixed-methods approach to understanding the complex issue of CWLs in PHC.
By using CWL data linked to administrative data in provinces with diverse approaches to CWLs, we will determine their comparative effectiveness attaching patients to PHC providers across Ontario, Quebec and Nova Scotia, and provider and patient characteristics. Further, by incorporating qualitative methods that will capture and delineate the contextual factors that influence patient attachment, we can open the “black box” of CWL effectiveness to determine the components, processes, and environments that promote their success.
PUPPY Study
Title: PUPPY Study - Problems Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year: A Longitudinal Mixed Methods Study with Rapid Reporting and Planning for the Road Ahead
Funding Agency: Canadian Institute of Health Research
Award: COVID-19 May 2020 Rapid Research Funding Operating Grant
Date: June 2020 - June 2023
Amount: $407, 552 (Canadian dollar)
Investigators: Marshall EG (Nominated Principal Applicant). Breton M (Co-Principal), Green M (Co-Principal), Isenor J (Co-Principal), Mathews M (Co-Principal), Andrew M (Co-investigator), Ashcroft R (Co-investigator), Bayoumi I (Co-investigator), Bishop A (Co-investigator), Bowles S (Co-investigator), Burge F (Co-investigator), Christian E (Co-investigator), Cossette B (Co-investigator), Dahrouge S (Co-investigator), Dolovich L (Co-investigator), Duhoux A (Co-investigator), Edwards L (Co-investigator), Gibson R (Co-investigator), Grant A (Co-investigator), Guénette L (Co-investigator), Harris M (Co-investigator), Kiran T (Co-investigator), Lawson B (Co-investigator), Lenskjold A (Co-investigator), MacKenzie A (Co-investigator), Martin-Misener R (Co-investigator), McDougall E (Co-investigator), McKay M (Co-investigator), Mccarthy L (Co-investigator), Morrison B (Co-investigator), Muphy A, (Co-investigator), Sampalli T (Co-investigator), Smithman M (Co-investigator), d'Entremont-MacVicar E (Co-investigator)
DESCRIPTION:
Visit our PUPPY Study page for more information
Funding Agency: Canadian Institute of Health Research
Award: COVID-19 May 2020 Rapid Research Funding Operating Grant
Date: June 2020 - June 2023
Amount: $407, 552 (Canadian dollar)
Investigators: Marshall EG (Nominated Principal Applicant). Breton M (Co-Principal), Green M (Co-Principal), Isenor J (Co-Principal), Mathews M (Co-Principal), Andrew M (Co-investigator), Ashcroft R (Co-investigator), Bayoumi I (Co-investigator), Bishop A (Co-investigator), Bowles S (Co-investigator), Burge F (Co-investigator), Christian E (Co-investigator), Cossette B (Co-investigator), Dahrouge S (Co-investigator), Dolovich L (Co-investigator), Duhoux A (Co-investigator), Edwards L (Co-investigator), Gibson R (Co-investigator), Grant A (Co-investigator), Guénette L (Co-investigator), Harris M (Co-investigator), Kiran T (Co-investigator), Lawson B (Co-investigator), Lenskjold A (Co-investigator), MacKenzie A (Co-investigator), Martin-Misener R (Co-investigator), McDougall E (Co-investigator), McKay M (Co-investigator), Mccarthy L (Co-investigator), Morrison B (Co-investigator), Muphy A, (Co-investigator), Sampalli T (Co-investigator), Smithman M (Co-investigator), d'Entremont-MacVicar E (Co-investigator)
DESCRIPTION:
Visit our PUPPY Study page for more information
3PCN Study
Title: Pandemic Planning for Primary Care: Developing an Integrated Response Framework for Family Physicians, Nurses, and Pharmacists
Funding Agency: Canadian Institute of Health Research
Award: Operating Grant: Emergency COVID-19 Research Gaps & Priorities - Health care systems and services
Date: December 2021 – November 2023
Amount: $499,616 (Canadian Dollar)
Investigators: Mathews M (Principal Applicant), Hedden L (Principal Investigator), Lukewich J (Principal Investigator), Marshall EG (Principal Investigator), Asghari S (Co-investigator), Brown J (Co-investigator), Bruneau J (Co-investigator), Cassell L (Co-investigator), Donnan J (Co-investigator), Elliott Rose A (Co-investigator), Freeman T (Co-investigator), Gill P (Co-investigator), Isenor J (Co-investigator), Letto A (Co-investigator), Martin-Misener R (Co-investigator), McCracken R (Co-investigator), Power L (Co-investigator), Ryan B (Co-investigator), Sibbald S (Co-investigator), Swanson M (Co-investigator), Terry A (Co-investigator), Wilson E (Co-investigator), Wong E (Co-investigator)
DESCRIPTION:
Background
Primary care providers play important roles in pandemic response and recovery. Primary care nurses (PC-N; i.e., Nurse Practitioners, Registered Nurses, and Licensed Practical Nurses) have been deployed from their routine responsibilities to take on pandemic-related roles. PC-N have played a critical role in regional and clinic-specific initiatives to ensure that screening, vaccination, and ongoing chronic disease management are available to marginalized populations. However, the roles, perspectives, and contributions of PC-N remain largely under-studied.
Research Questions and Objectives
What are the roles of PC-N during the COVID-19 pandemic and how do they contribute to regional, integrated pandemic plans for primary care? The projects builds on existing projects focused on family physicians (FP) and community-based pharmacists, and consists of two linked studies conducted in four provinces (Newfoundland and Labrador, Nova Scotia, Ontario, and British Columbia): the and PC-N Study. The goal of the PC-N Study is to describe the roles of PC-N during the Framework Development Study COVID-19 pandemic. The objectives are:
Methods
The PC-N Study consists of multiple case studies that will generate knowledge on PC-N roles and supports. In each region, we will conduct a document analysis to describe PC-N roles and the policies that support these roles in each stage of the pandemic and conduct semi-structured qualitative interviews with PC-N. In the interview, for each pandemic stage, we will ask PC-N to describe the facilitators and barriers to performing pandemic-related roles. We will use thematic analysis to analyse the transcripts in each region, and then compare and contrast across cases. In the Framework Development Study, we will use narrative synthesis to produce program logic models for pandemic response plans.
Rationale and Significance
This project will generate high-quality evidence to improve management of COVID-19 and enhance future pandemic preparedness. Individuals with complex chronic disease, mental health and substance-related health issues, and the elderly are particularly reliant on primary care to maintain their health during and following a pandemic. Primary care providers have played a central role in programs designed to improve access to care for marginalized populations. Innovations that emerged during the COVID-19 pandemic to address marginalized populations need to be incorporated into pandemic plans to ensure that promising practices and lessons learned during the COVID-19 pandemic are captured and used to prepare the response to future pandemics.
Funding Agency: Canadian Institute of Health Research
Award: Operating Grant: Emergency COVID-19 Research Gaps & Priorities - Health care systems and services
Date: December 2021 – November 2023
Amount: $499,616 (Canadian Dollar)
Investigators: Mathews M (Principal Applicant), Hedden L (Principal Investigator), Lukewich J (Principal Investigator), Marshall EG (Principal Investigator), Asghari S (Co-investigator), Brown J (Co-investigator), Bruneau J (Co-investigator), Cassell L (Co-investigator), Donnan J (Co-investigator), Elliott Rose A (Co-investigator), Freeman T (Co-investigator), Gill P (Co-investigator), Isenor J (Co-investigator), Letto A (Co-investigator), Martin-Misener R (Co-investigator), McCracken R (Co-investigator), Power L (Co-investigator), Ryan B (Co-investigator), Sibbald S (Co-investigator), Swanson M (Co-investigator), Terry A (Co-investigator), Wilson E (Co-investigator), Wong E (Co-investigator)
DESCRIPTION:
Background
Primary care providers play important roles in pandemic response and recovery. Primary care nurses (PC-N; i.e., Nurse Practitioners, Registered Nurses, and Licensed Practical Nurses) have been deployed from their routine responsibilities to take on pandemic-related roles. PC-N have played a critical role in regional and clinic-specific initiatives to ensure that screening, vaccination, and ongoing chronic disease management are available to marginalized populations. However, the roles, perspectives, and contributions of PC-N remain largely under-studied.
Research Questions and Objectives
What are the roles of PC-N during the COVID-19 pandemic and how do they contribute to regional, integrated pandemic plans for primary care? The projects builds on existing projects focused on family physicians (FP) and community-based pharmacists, and consists of two linked studies conducted in four provinces (Newfoundland and Labrador, Nova Scotia, Ontario, and British Columbia): the and PC-N Study. The goal of the PC-N Study is to describe the roles of PC-N during the Framework Development Study COVID-19 pandemic. The objectives are:
- to describe roles of PC-N during different stages of the COVID-19 pandemic, especially in relation to providing care for marginalized populations;
- to describe facilitators and barriers to the roles of PC-N during different stages of the COVID19 pandemic; and
- to compare and contrast PC-N roles, and the facilitators and barriers to these roles, across the four regions.
- to synthesize findings from related COVID-19 pandemic-focused studies on primary care providers (PC-N, FP, and community-based pharmacists); and
- to identify direct roles and resources/supports at the profession (PC-N, FP, and community-based pharmacists) and region level to support an integrated pandemic response for primary care.
Methods
The PC-N Study consists of multiple case studies that will generate knowledge on PC-N roles and supports. In each region, we will conduct a document analysis to describe PC-N roles and the policies that support these roles in each stage of the pandemic and conduct semi-structured qualitative interviews with PC-N. In the interview, for each pandemic stage, we will ask PC-N to describe the facilitators and barriers to performing pandemic-related roles. We will use thematic analysis to analyse the transcripts in each region, and then compare and contrast across cases. In the Framework Development Study, we will use narrative synthesis to produce program logic models for pandemic response plans.
Rationale and Significance
This project will generate high-quality evidence to improve management of COVID-19 and enhance future pandemic preparedness. Individuals with complex chronic disease, mental health and substance-related health issues, and the elderly are particularly reliant on primary care to maintain their health during and following a pandemic. Primary care providers have played a central role in programs designed to improve access to care for marginalized populations. Innovations that emerged during the COVID-19 pandemic to address marginalized populations need to be incorporated into pandemic plans to ensure that promising practices and lessons learned during the COVID-19 pandemic are captured and used to prepare the response to future pandemics.
FPN Study
Title: The Impact of Funding Models on the Integration of Registered Nurses in Primary Health Care Teams
Funding Agency: Canadian Institute of Health Research
Award: Project Grant
Date: September 2020 – August 2024
Amount: $263,333 (Canadian Dollar)
Investigators: Mathews M (Principal Applicant), Hedden L (Principal Investigator), Lukewich J (Principal Investigator), Brown J (Co-investigator), Green M (Co-investigator), Marshall EG (Co-investigator), McCracken R (Co-investigator), Norful A (Co-investigator), Poitras M (Co-investigator), Sibbald S (Co-investigator), Tranmer J (Co-investigator)
DESCRIPTION:
Background
Improving access to high-quality primary health care in Canada is a priority. Despite ongoing investments in primary health care, Canada continues to lag behind other countries in terms of quality, access, and cost of care. FP-RNs working in collaboration with family physicians and other health care providers, represents a feasible and affordable solution to these issues. FP-RNs co-managing patient care as members of interdisciplinary teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases; and to be cost effective. This project is a critical step towards integrating and optimizing family practice nursing within primary health care, and will benefit patients, primary healthcare providers, and healthcare systems nationally.
Primary health care reforms in Canada in the 2000s used different funding models to promote the introduction of FP-RNs in primary health care settings. However, it is unclear how well these funding models integrate FP-RNs into existing (i.e., predominantly fee-for-service) primary health care systems. As a result, FP-RNs are underutilized and miss opportunities to contribute to high-quality patient care. This project will address a gap in Canadian literature and aid provincial governments in structuring funding models that best optimize the roles of FP-RNs and realize benefits from team-based care. The results of the project will shed light on how funding models impact healthcare services and optimal professional practice deployment. The results will be useful to provinces that have already introduced funding reforms to integrate FP-RNs into primary health care settings as well as provinces (such as Newfoundland and Labrador or British Columbia) that have yet to introduce similar reforms.
By incorporating the Nursing Role Effectiveness Model, the results of the study incorporates an accepted framework to evaluate the integration of FP-RNs in primary health care. Funding models have important mediating effects that shape both what FP-RNs, and the health and health system outcomes they produce. By developing new ways of measuring nursing professional practice and co-management, the project contributes to the development of robust metrics to evaluate outcomes attributable to FP-RNs, which can be used in future patient outcomes research.
Research Questions and Objectives
What is the relationship between funding models and 1) nursing professional practice, 2) training and skill set needed by FP-RNs, 3) team functioning, and 4) co-management of patient care in primary health care settings? The goal of this project is to further the integration of FP-RNs in primary health care. The project consists of three studies: a funding model analysis, case studies, and a survey of FP-RNs. The research objectives are:
1. to describe and compare the various financial models used in Canada to integrate FP-RNs in primary health care [funding model analysis],
2. to explore the variation of nursing professional practice, training and skill set needed by FP-RNs, and team functioning in primary health care settings funded by traditional fee-for service, enhanced fee-for-service, capitation, and global funding in Ontario, Quebec, and Nova Scotia, [case studies], and
3. to examine the relationship between funding model, variation in nursing professional practice, training and skill sets needed by FP-RNs, team functioning, and patient care co-management of FP-RNs in primary health care settings in Canada [FP-RN survey].
We will use the Typology of Financial Models to classify and compare funding models. We hypothesize that funding models that are linked to the activities of all team providers and have interdependent provider remuneration will promote a broader range of independent activities, require broader training and skill set, promote better team functioning, and produce better co-management than funding models that are linked to the activities of a single provider and have hierarchically dependent provider remuneration.
Methods
The project employs a multiphase, mixed-methods design, and consists of three studies: the 1) funding model analysis, 2) case studies, and 3) FP-RN survey. The project uses the Nursing Role Effectiveness Model, an adaptation of Donabedian’s classic structure-process-outcomes model of quality of care. The project examines the relationship between the structure (nurse and organizational factors including funding model), process (professional practice of FP-RNs, team effectiveness) and outcomes (patient care co-management). Future research will incorporate patient level characteristics and outcomes.
The Nursing Role Effectiveness Model characterizes FP-RNs’ professional practice as independent, dependent, interdependent activities. RNs alone are accountable for independent activities which are autonomous, nurse-initiated, and carried out without a physician’s order (e.g. triage, patient assessment, and evaluation). Dependent activities are initiated by physician’s orders using the RN’s clinical judgement (e.g. implementing and coordinating care). Interdependent activities are carried out by RNs along with other health care providers, where each provider has a unique contribution to the activity (e.g. care coordination, quality improvement, team communication, etc.).
Rationale and Significance
This project will generate high-quality evidence to improve management of COVID-19 and enhance future pandemic preparedness. Individuals with complex chronic disease, mental health and substance-related health issues, and the elderly are particularly reliant on primary care to maintain their health during and following a pandemic. Primary care providers have played a central role in programs designed to improve access to care for marginalized populations. Innovations that emerged during the COVID-19 pandemic to address marginalized populations need to be incorporated into pandemic plans to ensure that promising practices and lessons learned during the COVID-19 pandemic are captured and used to prepare the response to future pandemics.
Funding Agency: Canadian Institute of Health Research
Award: Project Grant
Date: September 2020 – August 2024
Amount: $263,333 (Canadian Dollar)
Investigators: Mathews M (Principal Applicant), Hedden L (Principal Investigator), Lukewich J (Principal Investigator), Brown J (Co-investigator), Green M (Co-investigator), Marshall EG (Co-investigator), McCracken R (Co-investigator), Norful A (Co-investigator), Poitras M (Co-investigator), Sibbald S (Co-investigator), Tranmer J (Co-investigator)
DESCRIPTION:
Background
Improving access to high-quality primary health care in Canada is a priority. Despite ongoing investments in primary health care, Canada continues to lag behind other countries in terms of quality, access, and cost of care. FP-RNs working in collaboration with family physicians and other health care providers, represents a feasible and affordable solution to these issues. FP-RNs co-managing patient care as members of interdisciplinary teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases; and to be cost effective. This project is a critical step towards integrating and optimizing family practice nursing within primary health care, and will benefit patients, primary healthcare providers, and healthcare systems nationally.
Primary health care reforms in Canada in the 2000s used different funding models to promote the introduction of FP-RNs in primary health care settings. However, it is unclear how well these funding models integrate FP-RNs into existing (i.e., predominantly fee-for-service) primary health care systems. As a result, FP-RNs are underutilized and miss opportunities to contribute to high-quality patient care. This project will address a gap in Canadian literature and aid provincial governments in structuring funding models that best optimize the roles of FP-RNs and realize benefits from team-based care. The results of the project will shed light on how funding models impact healthcare services and optimal professional practice deployment. The results will be useful to provinces that have already introduced funding reforms to integrate FP-RNs into primary health care settings as well as provinces (such as Newfoundland and Labrador or British Columbia) that have yet to introduce similar reforms.
By incorporating the Nursing Role Effectiveness Model, the results of the study incorporates an accepted framework to evaluate the integration of FP-RNs in primary health care. Funding models have important mediating effects that shape both what FP-RNs, and the health and health system outcomes they produce. By developing new ways of measuring nursing professional practice and co-management, the project contributes to the development of robust metrics to evaluate outcomes attributable to FP-RNs, which can be used in future patient outcomes research.
Research Questions and Objectives
What is the relationship between funding models and 1) nursing professional practice, 2) training and skill set needed by FP-RNs, 3) team functioning, and 4) co-management of patient care in primary health care settings? The goal of this project is to further the integration of FP-RNs in primary health care. The project consists of three studies: a funding model analysis, case studies, and a survey of FP-RNs. The research objectives are:
1. to describe and compare the various financial models used in Canada to integrate FP-RNs in primary health care [funding model analysis],
2. to explore the variation of nursing professional practice, training and skill set needed by FP-RNs, and team functioning in primary health care settings funded by traditional fee-for service, enhanced fee-for-service, capitation, and global funding in Ontario, Quebec, and Nova Scotia, [case studies], and
3. to examine the relationship between funding model, variation in nursing professional practice, training and skill sets needed by FP-RNs, team functioning, and patient care co-management of FP-RNs in primary health care settings in Canada [FP-RN survey].
We will use the Typology of Financial Models to classify and compare funding models. We hypothesize that funding models that are linked to the activities of all team providers and have interdependent provider remuneration will promote a broader range of independent activities, require broader training and skill set, promote better team functioning, and produce better co-management than funding models that are linked to the activities of a single provider and have hierarchically dependent provider remuneration.
Methods
The project employs a multiphase, mixed-methods design, and consists of three studies: the 1) funding model analysis, 2) case studies, and 3) FP-RN survey. The project uses the Nursing Role Effectiveness Model, an adaptation of Donabedian’s classic structure-process-outcomes model of quality of care. The project examines the relationship between the structure (nurse and organizational factors including funding model), process (professional practice of FP-RNs, team effectiveness) and outcomes (patient care co-management). Future research will incorporate patient level characteristics and outcomes.
The Nursing Role Effectiveness Model characterizes FP-RNs’ professional practice as independent, dependent, interdependent activities. RNs alone are accountable for independent activities which are autonomous, nurse-initiated, and carried out without a physician’s order (e.g. triage, patient assessment, and evaluation). Dependent activities are initiated by physician’s orders using the RN’s clinical judgement (e.g. implementing and coordinating care). Interdependent activities are carried out by RNs along with other health care providers, where each provider has a unique contribution to the activity (e.g. care coordination, quality improvement, team communication, etc.).
Rationale and Significance
This project will generate high-quality evidence to improve management of COVID-19 and enhance future pandemic preparedness. Individuals with complex chronic disease, mental health and substance-related health issues, and the elderly are particularly reliant on primary care to maintain their health during and following a pandemic. Primary care providers have played a central role in programs designed to improve access to care for marginalized populations. Innovations that emerged during the COVID-19 pandemic to address marginalized populations need to be incorporated into pandemic plans to ensure that promising practices and lessons learned during the COVID-19 pandemic are captured and used to prepare the response to future pandemics.
PCPC Study
Title: Pan-Canadian Study of Psychiatric Care (PCPC)
Funding Agency: Canadian Institute of Health Research
Award: Project Grant
Date: July 2021 – June 2025
Amount: $232,500 (Canadian Dollar)
Investigators: Rudoler D (Principal Applicant), Lavergne M R (Principal Investigator), Marshall EG (Principal Investigator), Zaheer J (Principal Investigator), Bolton J (Co-investigator), Etches S (Co-investigator), Good K (Co-investigator), Katz A (Co-investigator), Kurdyak P (Co-investigator)
DESCRIPTION:
Background
About 70 percent of people do not see a psychiatrist in the 30 days following psychiatric hospitalization discharge, and about 60 percent do not see one within six months of suicide attempt. Poor access to psychiatric care could lead to relapse, re-hospitalization resulting in higher costs to the health care system, and even to death in the case of low post-suicide attempt follow up. Some argue that a psychiatrist shortage is to blame for access issues, though other factors may be contributing to low supply. In Ontario, there is an increasing concentration of psychiatrists in urban communities and corresponding rural under-supply of psychiatric care, and there is an aging workforce, which all suggests supply issues will persist. In addition, our team has found that practice volume and style play an important role in the supply of psychiatric care. About a quarter of all psychiatrists in Ontario see fewer than 100 patients per year and, on average, see them 16 times per year. High intensity psychiatric care may be beneficial following a crisis event like a suicide attempt, but these services are not accessed consistently by people with high needs.
Ontario is the only province where population-level research has been conducted to explore health human resource issues in the supply of publicly insured mental health services. There is an opportunity to extend this work to other parts of the country to determine if the service patterns observed in Ontario are consistent across the country. Care will be required when developing comparable indicators related to psychiatric care as data on physician billing and hospitalization classification differ across provinces. There is also an opportunity to use qualitative methods to explore why there is variation in psychiatric supply, why some psychiatrists choose to practice in different ways and in different settings, and whether patterns vary given different policy environments across Canada.
Research Questions and Objectives
1. Develop and evaluate comparable indicators of supply of psychiatric care across provinces.
2. Analyze variation and changes in the characteristics of the psychiatrist workforce, including demographics and practice style.
3. Study psychiatrist preferences for practice style, and the factors that lead to practice style selection.
Methods
This study will employ a cross-provincial, mixed-methods research design. Objectives 1 and 2 will involve an analysis of population-level administrative data in three provinces (British Columbia, Manitoba, and Ontario). Objective 3 will involve key informant interviews with psychiatrists in four provinces (including Nova Scotia), who are in various stages of career, and in various practice settings.
Rationale and Significance
This will be the first multi-provincial study of the psychiatric workforce in Canada, providing information necessary for planners to ensure adequate access to psychiatric care. Findings will be relevant for policy-makers, medical schools and professional associations across the country, and approaches developed for cross-provincial analysis will build capacity for future research.
Funding Agency: Canadian Institute of Health Research
Award: Project Grant
Date: July 2021 – June 2025
Amount: $232,500 (Canadian Dollar)
Investigators: Rudoler D (Principal Applicant), Lavergne M R (Principal Investigator), Marshall EG (Principal Investigator), Zaheer J (Principal Investigator), Bolton J (Co-investigator), Etches S (Co-investigator), Good K (Co-investigator), Katz A (Co-investigator), Kurdyak P (Co-investigator)
DESCRIPTION:
Background
About 70 percent of people do not see a psychiatrist in the 30 days following psychiatric hospitalization discharge, and about 60 percent do not see one within six months of suicide attempt. Poor access to psychiatric care could lead to relapse, re-hospitalization resulting in higher costs to the health care system, and even to death in the case of low post-suicide attempt follow up. Some argue that a psychiatrist shortage is to blame for access issues, though other factors may be contributing to low supply. In Ontario, there is an increasing concentration of psychiatrists in urban communities and corresponding rural under-supply of psychiatric care, and there is an aging workforce, which all suggests supply issues will persist. In addition, our team has found that practice volume and style play an important role in the supply of psychiatric care. About a quarter of all psychiatrists in Ontario see fewer than 100 patients per year and, on average, see them 16 times per year. High intensity psychiatric care may be beneficial following a crisis event like a suicide attempt, but these services are not accessed consistently by people with high needs.
Ontario is the only province where population-level research has been conducted to explore health human resource issues in the supply of publicly insured mental health services. There is an opportunity to extend this work to other parts of the country to determine if the service patterns observed in Ontario are consistent across the country. Care will be required when developing comparable indicators related to psychiatric care as data on physician billing and hospitalization classification differ across provinces. There is also an opportunity to use qualitative methods to explore why there is variation in psychiatric supply, why some psychiatrists choose to practice in different ways and in different settings, and whether patterns vary given different policy environments across Canada.
Research Questions and Objectives
1. Develop and evaluate comparable indicators of supply of psychiatric care across provinces.
2. Analyze variation and changes in the characteristics of the psychiatrist workforce, including demographics and practice style.
3. Study psychiatrist preferences for practice style, and the factors that lead to practice style selection.
Methods
This study will employ a cross-provincial, mixed-methods research design. Objectives 1 and 2 will involve an analysis of population-level administrative data in three provinces (British Columbia, Manitoba, and Ontario). Objective 3 will involve key informant interviews with psychiatrists in four provinces (including Nova Scotia), who are in various stages of career, and in various practice settings.
Rationale and Significance
This will be the first multi-provincial study of the psychiatric workforce in Canada, providing information necessary for planners to ensure adequate access to psychiatric care. Findings will be relevant for policy-makers, medical schools and professional associations across the country, and approaches developed for cross-provincial analysis will build capacity for future research.
SPARK Study
Title: Screening for Poverty And Related social determinants and intervening to improve Knowledge of and links to resources (SPARK) Study
Funding Agency: Canadian Institute of Health Research
Award: Operating Grant: SPOR PIHCI Network: Programmatic Grants
Date: February 2018 - March 2024
Amount: $250,000 (Canadian Dollar)
Investigators: Pinto A D (Principal Applicant), Aubrey-Bassler F K (Principal Investigator), Marshall EG (Principal Investigator), Katz A (Principal Investigator), Muhajarine N (Principal Investigator), Neudorf C O (Principal Investigator), Robinson M (Principal Investigator), Allin S (Co-investigator), Bayoumi I (Co-investigator), Bellaire J (Co-investigator), Bennett-Abuayyash C (Co-investigator), Betker C (Co-investigator), Bhattacharyya O (Co-investigator), Bloch G (Co-investigator), Blonde Y (Co-investigator), Brcic V (Co-investigator), Burnside B (Co-investigator), Clarke S (Co-investigator), Cooney J (Co-investigator), Damba C (Co-investigator), Edwards J (Co-investigator), Garg A (Co-investigator), Ghose S (Co-investigator), Gibson R (Co-investigator), Glazier R (Co-investigator), Goel R (Co-investigator), Gogan A (Co-investigator), Goold S (Co-investigator), Gottlieb L (Co-investigator), Graham P (Co-investigator), Greenberg A (Co-investigator), Greiver M (Co-investigator), Halas G (Co-investigator), Jones A (Co-investigator), Kanee M (Co-investigator), Kiran T (Co-investigator), Kryzanowski J (Co-investigator), Lacetera N (Co-investigator), Lees M (Co-investigator), Lofters A (Co-investigator), Lohman W (Co-investigator), Mahood S (Co-investigator), Murphy L (Co-investigator), Nisenbaum R (Co-investigator), Persaud N (Co-investigator), Pham T (Co-investigator), Purkey E (Co-investigator), Rayner J (Co-investigator), Roos N (Co-investigator), Sampalli T (Co-investigator), Schwandt M (Co-investigator), Shah A (Co-investigator), Singer A (Co-investigator), Smith R (Co-investigator), Thanos J (Co-investigator), Ugolini C (Co-investigator), Upshur R (Co-investigator), Walji S (Co-investigator), Webster F (Co-investigator), Williams-Roberts H (Co-investigator)
DESCRIPTION:
Taking action on the social determinants of health in healthcare settings
The social conditions and processes that impact the health of individuals and communities have been labeled the social determinants of health (SDOH). These are “the conditions in which people are born, grow, live, work and age”, and include factors at the individual level (e.g., income, educational attainment), neighbourhood level (e.g. built environment, access to healthy foods), population level (e.g. social attitudes towards people of different race/ethnicity), and structural level (e.g. political and economic conditions). That health is strongly influenced by social needs and social processes has been appreciated for thousands of years. However, the past century has been dominated by a biomedical approach to health, particularly within Western countries. This has started to change, and several major health organizations, including the World Health Organization, British Medical Association, Canadian Medical Association, the College of Family Physicians of Canada and the Registered Nurses’ Association of Ontario have committed to focusing on SDOH. Health policymakers and health service researchers have also identified addressing SDOH as key to achieving health system goals and addressing the needs of medically and socially complex patients. Indeed, SDOH have been consistently identified as key predictors of high health services use.
The last decade has seen a major advancement in the involvement of primary care teams in direct interventions on SDOH. At the patient-provider level these include the development of clinical tools focused on helping raise the incomes of people living in poverty, and education sessions on SDOH interventions for all levels of medical trainees and practicing physicians. Medical-legal partnerships have been another intervention to address SDOH, where lawyers are engaged in addressing poor housing conditions, violations of employee rights, citizenship and immigration concerns, and helping patients appeal decisions of social benefit tribunals. The College of Family Physicians of Canada issued a clinical practice guideline, outlining roles that members could play at the micro-, meso- and macro-level, fitting with ongoing calls for family medicine to achieve its goal of social accountability. However, a recent systematic review of the literature on addressing SDOH in health care settings found that evidence in support of such interventions remains limited. Addressing SDOH directly and going “upstream” of illness and disease remains uncommon in the Canadian health system. Health providers face a number of barriers to addressing social needs, including a lack of time, a lack of expertise in identifying needs, limited knowledge of community resources, education and training that remains focused on a biomedical understanding of health and disease, and funding that remains directed to “downstream” and acute health concerns.
Data to enable upstream action
While much is known about SDOH, we lack the individual-level data necessary to develop targeted interventions. Sociodemographic data collected at the individual level, paired with interventions to meet social needs when identified, could address this problem. Further, robust sociodemographic data linked to electronic medical records (EMRs) can support quality improvement and new care pathways at the organizational level, planning and resource allocation at the system level, and advance research on health inequities.
In Canada and in many countries, evidence on health inequities – such as unfair and unjust differences in access to health services or differences in health outcomes across social, economic and cultural groups in society – is typically derived from a combination of surveys and administrative data. These provide data on large geographic areas, but not for small populations, such as a clinic practice or hospital catchment area. Further, certain groups are likely to be missing from such data sources, including Indigenous populations, those without legal status, those without housing and other “hard to reach” groups. Few health organizations routinely collect robust sociodemographic data and fewer still link such data to their EMRs.
At least four uses of such data can be identified. First, and of highest priority to patients, this data can be used to identify social needs at the point-of-care. In the United States, studies in paediatric settings have found that it is feasible and acceptable to screen for social needs (including poverty) and intervene to connect patients and families to community resources. One cluster RCT involving eight community health centres in Boston, MA found that routine screening of families for social needs followed by the provision of written information on resources and a one-month follow-up phone call was associated with improved access to community resources, as well as reductions in social needs. Subsequently, a RCT in the San Francisco Bay Area evaluated the “Health Leads” model, where trained volunteers equipped with information on community resources assist patients with social needs. Families presenting at two safety-net hospitals, compared written information on resources to in-person navigation with follow-up telephone calls. In this study, written information on resources alone had little impact, but those receiving in-person navigation and follow-up had reduced social needs and significant improvements in child health. Additional evaluations of this model have found that addressing social needs may be associated with improvements in health outcomes in adults. Second, such data summarized for organizations can support quality improvement by primary care, particularly to examine equity, and inform the development of new care pathways. There is substantial evidence that Canadians experience differential treatment by the healthcare system, based on age, gender, race and other social characteristics. Low income Canadians are more likely to experience discrimination when seeking a family physician and in access to specialists compared to wealthy Canadians. Canadians with lower educational attainment are also less likely to have access to specialists than those with higher education. Other factors that influence who receives service and who does not, and the quality of the service received, include gender identity, sexual orientation, disability status, preferred language, housing status and race or ethnicity. Robust sociodemographic data can help health organizations identify such inequities in access and also help them with the early identification of differences in health outcomes across groups. For example, members of our team have used such data to identify differences in cancer screening rates. Other organizations have used similar data to inform training for staff to improve inclusivity, to inform decisions about which languages to translate materials into, and to track differences in health outcomes. Third, when robust sociodemographic data is collected in the same way by all organizations in a region it has potential for health system planning, for resource allocation and to be used by public health. Fourth, when embedded in EMRs, this data can greatly advance research on health inequities, as sociodemographic variables can be incorporated into epidemiological studies and changes in social needs can be followed as possible outcomes of an intervention.
Past work by the study team
Sociodemographic data collection in Toronto
The Tri-Hospital Plus TPH Health Equity Data Collection Collaborative was an initiative supported by the Toronto Central Local Health Integration Network (TC LHIN) and engaged St. Michael’s Hospital, Mount Sinai Hospital, the Centre for Addiction and Mental Health and Toronto Public Health. The Collaborative reached consensus on a set of questions to be administered by each institution in the form of pilot projects. These included questions about language, immigration, race/ethnicity, religion, disability, gender identity, sexual orientation, income, and housing. During June 2012 to August 2012, each institution collected data in a different location on approximately 400 patients. The St. Michael’s Hospital Academic Family Health Team (SMHAFHT) participated in the initial pilot of the questions and has been routinely collecting data using the HEQ since December 2013. TC LHIN health institutions were encouraged to routinely collect this data using what is now called the “Health Equity Questions” (HEQ), supported by tools, training and resources developed and delivered by staff at the Office of Human Rights and Health Equity at Mount Sinai Hospital.
Research team members recently completed an assessment of the HEQ, based on the experience of 42,396 patients who had at least one physician visit during Dec 2013-March 2016. It was found that only 36% of patients were offered the HEQ, suggesting that staff training and quality assurance mechanisms are key. If offered the survey, only 6% declined. Interviews with patients, clinicians, and the leadership team at SMHAFHT revealed the significant potential of the HEQ, including understanding inequities in care and outcomes and developing programs to meet the unique needs of the population served. Valuable insights were gained into how the questions perform, compared to other data in the chart.
Sociodemographic data collection in Saskatoon
The Saskatoon Health Region in Saskatchewan, Canada developed an initiative called ‘We Ask Because We Care’ to support the collection and application of sociodemographic data in healthcare settings. The initiative was implemented in three diverse urban healthcare settings including a primary health centre, community-based organization and registration department of an inner-city hospital. A questionnaire developed by the Tri-Hospital Plus Toronto Public Health Equity Data Collection Collaborative was adapted for the project. Questions pertaining to food security, diagnosis with an intersex condition and preferred pronoun were added to those adopted such as language, place of birth, immigration status, race/ethnicity, gender identity, disability, sexual orientation, housing, and annual household income. An evaluation of the process of implementation found the survey was acceptable and feasible, but was dependent on how patients were informed about the purpose of data collection and the degree of trust in health institutions.
Establishing a standard set of questions on sociodemographic and social needs
Building on this work, the study team adapted the HEQ into the “SPARK Tool” referred to as the SPARK Survey when used by patients and in clinic. The tool was tested in five primary care clinics in Ontario. Psychometric testing and validation in the SPARK Psychometric Testing and Perspectives Study was carried out in Ontario, Manitoba, Saskatchewan, and Newfoundland and Labrador. All of this work has been supported by patient partners and through consultation with the Canadian Institute for Health Information (CIHI), StatsCanada, Ontario Health, Better Outcomes Registry and Network (BORN), First Nation Information Governance Center (FNIGC), Health Data Research Network Canada (HDRN), Canada Health Infoway, and others. The current SPARK Tool is a sociodemographic survey with 17 core questions and 2 optional questions. Questions relate to demographics and social needs. The SPARK Tool has been revised based on extensive Advisory Group feedback as well as perspectives data from 190 patients across Canada. It will be used in five different provinces during this study and has been finalized as of April 26, 2022.
Research Questions and Objectives
1) Is it acceptable and feasible to collect robust sociodemographic and social needs data in diverse primary care organizations in Canada?
Hypothesis: Our hypothesis is that primary care organizations are able to implement robust sociodemographic and social needs data collection, contingent on the support of leadership and appropriate resources to physicians and other clinic staff.
2) How do primary care organizations use robust sociodemographic and social needs data in clinical care, Quality Improvement (QI) activities and organizational changes?
Hypothesis: Our hypothesis is that primary care organizations range in their ability to extract, analyze and use robust sociodemographic and social needs data, dependent on internal resources and commitment to using the data.
Methods
This is a mixed-methods implementation evaluation guided by the framework for outcomes in implementation research by Proctor et al and the Consolidated Framework for Advancing Implementation Science.
Funding Agency: Canadian Institute of Health Research
Award: Operating Grant: SPOR PIHCI Network: Programmatic Grants
Date: February 2018 - March 2024
Amount: $250,000 (Canadian Dollar)
Investigators: Pinto A D (Principal Applicant), Aubrey-Bassler F K (Principal Investigator), Marshall EG (Principal Investigator), Katz A (Principal Investigator), Muhajarine N (Principal Investigator), Neudorf C O (Principal Investigator), Robinson M (Principal Investigator), Allin S (Co-investigator), Bayoumi I (Co-investigator), Bellaire J (Co-investigator), Bennett-Abuayyash C (Co-investigator), Betker C (Co-investigator), Bhattacharyya O (Co-investigator), Bloch G (Co-investigator), Blonde Y (Co-investigator), Brcic V (Co-investigator), Burnside B (Co-investigator), Clarke S (Co-investigator), Cooney J (Co-investigator), Damba C (Co-investigator), Edwards J (Co-investigator), Garg A (Co-investigator), Ghose S (Co-investigator), Gibson R (Co-investigator), Glazier R (Co-investigator), Goel R (Co-investigator), Gogan A (Co-investigator), Goold S (Co-investigator), Gottlieb L (Co-investigator), Graham P (Co-investigator), Greenberg A (Co-investigator), Greiver M (Co-investigator), Halas G (Co-investigator), Jones A (Co-investigator), Kanee M (Co-investigator), Kiran T (Co-investigator), Kryzanowski J (Co-investigator), Lacetera N (Co-investigator), Lees M (Co-investigator), Lofters A (Co-investigator), Lohman W (Co-investigator), Mahood S (Co-investigator), Murphy L (Co-investigator), Nisenbaum R (Co-investigator), Persaud N (Co-investigator), Pham T (Co-investigator), Purkey E (Co-investigator), Rayner J (Co-investigator), Roos N (Co-investigator), Sampalli T (Co-investigator), Schwandt M (Co-investigator), Shah A (Co-investigator), Singer A (Co-investigator), Smith R (Co-investigator), Thanos J (Co-investigator), Ugolini C (Co-investigator), Upshur R (Co-investigator), Walji S (Co-investigator), Webster F (Co-investigator), Williams-Roberts H (Co-investigator)
DESCRIPTION:
Taking action on the social determinants of health in healthcare settings
The social conditions and processes that impact the health of individuals and communities have been labeled the social determinants of health (SDOH). These are “the conditions in which people are born, grow, live, work and age”, and include factors at the individual level (e.g., income, educational attainment), neighbourhood level (e.g. built environment, access to healthy foods), population level (e.g. social attitudes towards people of different race/ethnicity), and structural level (e.g. political and economic conditions). That health is strongly influenced by social needs and social processes has been appreciated for thousands of years. However, the past century has been dominated by a biomedical approach to health, particularly within Western countries. This has started to change, and several major health organizations, including the World Health Organization, British Medical Association, Canadian Medical Association, the College of Family Physicians of Canada and the Registered Nurses’ Association of Ontario have committed to focusing on SDOH. Health policymakers and health service researchers have also identified addressing SDOH as key to achieving health system goals and addressing the needs of medically and socially complex patients. Indeed, SDOH have been consistently identified as key predictors of high health services use.
The last decade has seen a major advancement in the involvement of primary care teams in direct interventions on SDOH. At the patient-provider level these include the development of clinical tools focused on helping raise the incomes of people living in poverty, and education sessions on SDOH interventions for all levels of medical trainees and practicing physicians. Medical-legal partnerships have been another intervention to address SDOH, where lawyers are engaged in addressing poor housing conditions, violations of employee rights, citizenship and immigration concerns, and helping patients appeal decisions of social benefit tribunals. The College of Family Physicians of Canada issued a clinical practice guideline, outlining roles that members could play at the micro-, meso- and macro-level, fitting with ongoing calls for family medicine to achieve its goal of social accountability. However, a recent systematic review of the literature on addressing SDOH in health care settings found that evidence in support of such interventions remains limited. Addressing SDOH directly and going “upstream” of illness and disease remains uncommon in the Canadian health system. Health providers face a number of barriers to addressing social needs, including a lack of time, a lack of expertise in identifying needs, limited knowledge of community resources, education and training that remains focused on a biomedical understanding of health and disease, and funding that remains directed to “downstream” and acute health concerns.
Data to enable upstream action
While much is known about SDOH, we lack the individual-level data necessary to develop targeted interventions. Sociodemographic data collected at the individual level, paired with interventions to meet social needs when identified, could address this problem. Further, robust sociodemographic data linked to electronic medical records (EMRs) can support quality improvement and new care pathways at the organizational level, planning and resource allocation at the system level, and advance research on health inequities.
In Canada and in many countries, evidence on health inequities – such as unfair and unjust differences in access to health services or differences in health outcomes across social, economic and cultural groups in society – is typically derived from a combination of surveys and administrative data. These provide data on large geographic areas, but not for small populations, such as a clinic practice or hospital catchment area. Further, certain groups are likely to be missing from such data sources, including Indigenous populations, those without legal status, those without housing and other “hard to reach” groups. Few health organizations routinely collect robust sociodemographic data and fewer still link such data to their EMRs.
At least four uses of such data can be identified. First, and of highest priority to patients, this data can be used to identify social needs at the point-of-care. In the United States, studies in paediatric settings have found that it is feasible and acceptable to screen for social needs (including poverty) and intervene to connect patients and families to community resources. One cluster RCT involving eight community health centres in Boston, MA found that routine screening of families for social needs followed by the provision of written information on resources and a one-month follow-up phone call was associated with improved access to community resources, as well as reductions in social needs. Subsequently, a RCT in the San Francisco Bay Area evaluated the “Health Leads” model, where trained volunteers equipped with information on community resources assist patients with social needs. Families presenting at two safety-net hospitals, compared written information on resources to in-person navigation with follow-up telephone calls. In this study, written information on resources alone had little impact, but those receiving in-person navigation and follow-up had reduced social needs and significant improvements in child health. Additional evaluations of this model have found that addressing social needs may be associated with improvements in health outcomes in adults. Second, such data summarized for organizations can support quality improvement by primary care, particularly to examine equity, and inform the development of new care pathways. There is substantial evidence that Canadians experience differential treatment by the healthcare system, based on age, gender, race and other social characteristics. Low income Canadians are more likely to experience discrimination when seeking a family physician and in access to specialists compared to wealthy Canadians. Canadians with lower educational attainment are also less likely to have access to specialists than those with higher education. Other factors that influence who receives service and who does not, and the quality of the service received, include gender identity, sexual orientation, disability status, preferred language, housing status and race or ethnicity. Robust sociodemographic data can help health organizations identify such inequities in access and also help them with the early identification of differences in health outcomes across groups. For example, members of our team have used such data to identify differences in cancer screening rates. Other organizations have used similar data to inform training for staff to improve inclusivity, to inform decisions about which languages to translate materials into, and to track differences in health outcomes. Third, when robust sociodemographic data is collected in the same way by all organizations in a region it has potential for health system planning, for resource allocation and to be used by public health. Fourth, when embedded in EMRs, this data can greatly advance research on health inequities, as sociodemographic variables can be incorporated into epidemiological studies and changes in social needs can be followed as possible outcomes of an intervention.
Past work by the study team
Sociodemographic data collection in Toronto
The Tri-Hospital Plus TPH Health Equity Data Collection Collaborative was an initiative supported by the Toronto Central Local Health Integration Network (TC LHIN) and engaged St. Michael’s Hospital, Mount Sinai Hospital, the Centre for Addiction and Mental Health and Toronto Public Health. The Collaborative reached consensus on a set of questions to be administered by each institution in the form of pilot projects. These included questions about language, immigration, race/ethnicity, religion, disability, gender identity, sexual orientation, income, and housing. During June 2012 to August 2012, each institution collected data in a different location on approximately 400 patients. The St. Michael’s Hospital Academic Family Health Team (SMHAFHT) participated in the initial pilot of the questions and has been routinely collecting data using the HEQ since December 2013. TC LHIN health institutions were encouraged to routinely collect this data using what is now called the “Health Equity Questions” (HEQ), supported by tools, training and resources developed and delivered by staff at the Office of Human Rights and Health Equity at Mount Sinai Hospital.
Research team members recently completed an assessment of the HEQ, based on the experience of 42,396 patients who had at least one physician visit during Dec 2013-March 2016. It was found that only 36% of patients were offered the HEQ, suggesting that staff training and quality assurance mechanisms are key. If offered the survey, only 6% declined. Interviews with patients, clinicians, and the leadership team at SMHAFHT revealed the significant potential of the HEQ, including understanding inequities in care and outcomes and developing programs to meet the unique needs of the population served. Valuable insights were gained into how the questions perform, compared to other data in the chart.
Sociodemographic data collection in Saskatoon
The Saskatoon Health Region in Saskatchewan, Canada developed an initiative called ‘We Ask Because We Care’ to support the collection and application of sociodemographic data in healthcare settings. The initiative was implemented in three diverse urban healthcare settings including a primary health centre, community-based organization and registration department of an inner-city hospital. A questionnaire developed by the Tri-Hospital Plus Toronto Public Health Equity Data Collection Collaborative was adapted for the project. Questions pertaining to food security, diagnosis with an intersex condition and preferred pronoun were added to those adopted such as language, place of birth, immigration status, race/ethnicity, gender identity, disability, sexual orientation, housing, and annual household income. An evaluation of the process of implementation found the survey was acceptable and feasible, but was dependent on how patients were informed about the purpose of data collection and the degree of trust in health institutions.
Establishing a standard set of questions on sociodemographic and social needs
Building on this work, the study team adapted the HEQ into the “SPARK Tool” referred to as the SPARK Survey when used by patients and in clinic. The tool was tested in five primary care clinics in Ontario. Psychometric testing and validation in the SPARK Psychometric Testing and Perspectives Study was carried out in Ontario, Manitoba, Saskatchewan, and Newfoundland and Labrador. All of this work has been supported by patient partners and through consultation with the Canadian Institute for Health Information (CIHI), StatsCanada, Ontario Health, Better Outcomes Registry and Network (BORN), First Nation Information Governance Center (FNIGC), Health Data Research Network Canada (HDRN), Canada Health Infoway, and others. The current SPARK Tool is a sociodemographic survey with 17 core questions and 2 optional questions. Questions relate to demographics and social needs. The SPARK Tool has been revised based on extensive Advisory Group feedback as well as perspectives data from 190 patients across Canada. It will be used in five different provinces during this study and has been finalized as of April 26, 2022.
Research Questions and Objectives
1) Is it acceptable and feasible to collect robust sociodemographic and social needs data in diverse primary care organizations in Canada?
Hypothesis: Our hypothesis is that primary care organizations are able to implement robust sociodemographic and social needs data collection, contingent on the support of leadership and appropriate resources to physicians and other clinic staff.
2) How do primary care organizations use robust sociodemographic and social needs data in clinical care, Quality Improvement (QI) activities and organizational changes?
Hypothesis: Our hypothesis is that primary care organizations range in their ability to extract, analyze and use robust sociodemographic and social needs data, dependent on internal resources and commitment to using the data.
Methods
This is a mixed-methods implementation evaluation guided by the framework for outcomes in implementation research by Proctor et al and the Consolidated Framework for Advancing Implementation Science.
3PC Study
Title: Pandemic Planning for Primary Care: Lessons from Four Provinces
Funding Agency: Canadian Institute of Health Research
Award: COVID-19 May 2020 Rapid Research Funding Operating Grant
Date: June 2020 - June 2023
Amount: $380,309 (Canadian Dollar)
Investigators: Mathews M (Principal Applicant), Marshall EG (Principal Investigator), Hedden L (Principal Investigator), Lukewich J (Principal Investigator), Asghari S (Co-investigator), Aubrey-Bassler K (Co-investigator), Brown J (Co-investigator), Christian E (Co-investigator), Freeman T (Co-investigator), Gill P (Co-investigator), Kim G, (Co-investigator), McCracken R (Co-investigator), Ryan B (Co-investigator), Schacter G, (Co-investigator), Sibbald S (Co-investigator), Strydom N (Co-applicant), Terry A (Co-investigator), Thind A (Co-investigator), Wong E (Co-investigator), Alexaiadis M, (Co-investigator), McKay M, (Co-investigator), Summers A (Co-investigator), Wickett J (Co-investigator), Young J (Co-investigator)
DESCRIPTION:
Background
Family physicians (FP) play an important role in pandemic response and recovery. However, existing pandemic plans do not adequately incorporate FP, account for the need to keep community-based practices open, or address the surge in demand for services following the pandemic when large volumes of patients who have delayed or forgone care during the pandemic require primary care.
Research Questions and Objectives
What are the roles of FP during a pandemic? What facilitates and hinders FP from fulfilling these roles? The goal of the project is to inform the development of pandemic plans for FP by examining experiences in regions in four provinces in Canada: Newfoundland and Labrador, Nova Scotia, Ontario, and British Columbia. The specific objectives are:
1. to describe the proposed, actual, and potential roles of FP during different stages of the COVID-19 pandemic;
2. to describe the facilitators and barriers to the proposed, actual, and potential FP roles during different stages of the COVID-19 pandemic;
3. to describe gender differences in the roles, facilitators and barriers of FP during different stages of the COVID-19 pandemic; and
4. to compare and contrast the proposed, actual, and potential roles of roles of FP and the facilitators and barriers to these FP roles across the four provinces.
By roles, we mean specific tasks and/or responsibilities that FP are asked or required to do during the stages of the pandemic. These roles are expected to cease once the pandemic is over and 'normal' operations resume. We expect that the project will highlight gaps in current pandemic response plans; identify variation along traits such as urban/rural location, affiliation with regional organizational structures, funding models, and gender; and illustrate promising practices and key facilitators.
Methods
The project is a multiple case study of regions in four provinces. Each case consists of a two-part mixed-methods design consisting of: 1) chronology of FP roles in the COVID-19 pandemic response and 2) qualitative interviews with FP. In each province, we will create the chronology through a document review (supplemented, as needed, by key informant interviews) to describe key milestones in COVID-19 pandemic and FP roles and responsibilities at each stage of the pandemic. In the chronology, we will note the progression of the pandemic; declarations and actions; directives and guidance for patients, institutions and FP; and responses from FP and patients. Using the chronology as common frame of reference, we will conduct semi-structured qualitative interviews with FP who work in each region. In the interview, for each pandemic stage, we will ask FP to describe the facilitators and barriers to performing the proposed, actual and potential roles FP, and the influence of their gender on roles, facilitators and barriers. We will use thematic analysis to analyse the transcripts in each region, and then compare and contrast across cases to identify promising practices.
Rationale and Significance
Short-term, emerging results can inform the response to subsequent waves of COVID-19. In the longer term, the project will inform future pandemic preparation.
Funding Agency: Canadian Institute of Health Research
Award: COVID-19 May 2020 Rapid Research Funding Operating Grant
Date: June 2020 - June 2023
Amount: $380,309 (Canadian Dollar)
Investigators: Mathews M (Principal Applicant), Marshall EG (Principal Investigator), Hedden L (Principal Investigator), Lukewich J (Principal Investigator), Asghari S (Co-investigator), Aubrey-Bassler K (Co-investigator), Brown J (Co-investigator), Christian E (Co-investigator), Freeman T (Co-investigator), Gill P (Co-investigator), Kim G, (Co-investigator), McCracken R (Co-investigator), Ryan B (Co-investigator), Schacter G, (Co-investigator), Sibbald S (Co-investigator), Strydom N (Co-applicant), Terry A (Co-investigator), Thind A (Co-investigator), Wong E (Co-investigator), Alexaiadis M, (Co-investigator), McKay M, (Co-investigator), Summers A (Co-investigator), Wickett J (Co-investigator), Young J (Co-investigator)
DESCRIPTION:
Background
Family physicians (FP) play an important role in pandemic response and recovery. However, existing pandemic plans do not adequately incorporate FP, account for the need to keep community-based practices open, or address the surge in demand for services following the pandemic when large volumes of patients who have delayed or forgone care during the pandemic require primary care.
Research Questions and Objectives
What are the roles of FP during a pandemic? What facilitates and hinders FP from fulfilling these roles? The goal of the project is to inform the development of pandemic plans for FP by examining experiences in regions in four provinces in Canada: Newfoundland and Labrador, Nova Scotia, Ontario, and British Columbia. The specific objectives are:
1. to describe the proposed, actual, and potential roles of FP during different stages of the COVID-19 pandemic;
2. to describe the facilitators and barriers to the proposed, actual, and potential FP roles during different stages of the COVID-19 pandemic;
3. to describe gender differences in the roles, facilitators and barriers of FP during different stages of the COVID-19 pandemic; and
4. to compare and contrast the proposed, actual, and potential roles of roles of FP and the facilitators and barriers to these FP roles across the four provinces.
By roles, we mean specific tasks and/or responsibilities that FP are asked or required to do during the stages of the pandemic. These roles are expected to cease once the pandemic is over and 'normal' operations resume. We expect that the project will highlight gaps in current pandemic response plans; identify variation along traits such as urban/rural location, affiliation with regional organizational structures, funding models, and gender; and illustrate promising practices and key facilitators.
Methods
The project is a multiple case study of regions in four provinces. Each case consists of a two-part mixed-methods design consisting of: 1) chronology of FP roles in the COVID-19 pandemic response and 2) qualitative interviews with FP. In each province, we will create the chronology through a document review (supplemented, as needed, by key informant interviews) to describe key milestones in COVID-19 pandemic and FP roles and responsibilities at each stage of the pandemic. In the chronology, we will note the progression of the pandemic; declarations and actions; directives and guidance for patients, institutions and FP; and responses from FP and patients. Using the chronology as common frame of reference, we will conduct semi-structured qualitative interviews with FP who work in each region. In the interview, for each pandemic stage, we will ask FP to describe the facilitators and barriers to performing the proposed, actual and potential roles FP, and the influence of their gender on roles, facilitators and barriers. We will use thematic analysis to analyse the transcripts in each region, and then compare and contrast across cases to identify promising practices.
Rationale and Significance
Short-term, emerging results can inform the response to subsequent waves of COVID-19. In the longer term, the project will inform future pandemic preparation.
ECPC Study
Title: Practice patterns among early-career primary care physicians and workforce planning implications: a mixed methods study
Funding Agency: Canadian Institute of Health Research
Award: Project Grant
Date: June 2018 - June 2023
Amount: $1,243,124 (Canadian dollar)
Investigators: Lavergne M (Principal Investigator), Marshall EG (Principal Investigator), Rudoler D (Principal Investigator), Grudniewicz A (Principal Investigator), Goldsmith L (Principal Investigator), Burge F (Co-investigator), Gibson R (Co-investigator), Glazier R (Co-investigator), Hawrylyshyn S (Co-investigator), Hedden L (Co-investigator), Hernandez-Lee J (Co-investigator), Horrey K (Co-investigator), Joyce M (Co-investigator), Kiran T (Co-investigator), MacKenzie A (Co-investigator), Mathews M (Co-investigator), McGrail K (Co-investigator), McPherson C (Co-investigator), Mitra G (Co-investigator), Sampalli T (Co-investigator), Scott I (Co-investigator), Snadden D (Co-investigator), Tomblin Murphy G (Co-investigator), Wong S (Co-investigator), Blackie D (Collaborator), Brown K (Collaborator), Cramb L (Collaborator), McKinnon L (Collaborator
DESCRIPTION:
Rationale: Reports of patients’ difficulty finding a primary care provider and accessing primary care
services persist though there are more primary care physicians (PCPs) per capita than ever before in
Canada. Understanding and addressing this apparent gap between growing per-capita physician supply and unmet patient needs for care is an urgent priority for policymakers.
There is widespread speculation that the expectations and practice choices of early-career PCPs are
changing relative to previous cohorts, but little evidence to support or refute this claim. We know there have always been differences in practice between early-career and established PCPs, but not if differences are growing. PCPs overall, or early-career PCPs specifically, may be working less, choosing practice with a specialized clinical focus, or choosing walk-in clinic practice, locums, or hospitalist care, rather than comprehensive family medicine. However, most workforce planning models implicitly assume that practice patterns are homogenous across cohorts and static over time.
The overarching of this project is to inform primary care planning by addressing gaps in existing goal knowledge about changes within the primary care physician workforce.
Objectives
1) Identify what values and preferences, including attributes of clinical work as well as lifestyle and financial considerations, shape the intentions and choices of family medicine residents and early career PCPs.
2) Compare practice patterns among early-career (<10 years in practice) and established (10+ years) PCPs and determine if any changes over time reflect cohort effects (attributes unique to the most recent cohort of PCPs), or period effects (changes over time across all PCPs).
3) Using the evidence generated under Objectives 1 and 2, engage stakeholders (post-graduate medical residents, early career physicians, and primary care and health workforce policymakers) in discussions of practice options, implications for primary care supply, and promising targets for intervention.
Methods: We propose a mixed-methods research design in British Columbia (BC), Ontario (ON), and Nova Scotia (NS), provinces with variable policy environments for primary care and collectively over half of the Canadian population. To address Objective 1, we will conduct semi-structured in-depth interviews with family medicine residents and early-career PCPs and analyze survey data collected by the College of Family Physicians of Canada. We will address Objective 2 through quantitative analysis of administrative health data, linked within each province and with comparable analytic approaches across provinces. To address Objective 3 we will compare results from Objectives 1 and 2 with available practice models to inform a series of deliberative dialogues with residents, early-career physicians, and policymakers.
This project will produce a framework to understand practice choices, newSignificance and impact: measures for comparing practice patterns, and information necessary for planners to ensure adequate provider supply and patient access to primary care. It will inform what policy changes could alter physician practice choices, or compensate for changes in physician service delivery. Findings will be relevant to many jurisdictions that face similar challenges of primary care access and workforce planning. Approaches developed for cross-provincial analysis will build capacity for future research.
Funding Agency: Canadian Institute of Health Research
Award: Project Grant
Date: June 2018 - June 2023
Amount: $1,243,124 (Canadian dollar)
Investigators: Lavergne M (Principal Investigator), Marshall EG (Principal Investigator), Rudoler D (Principal Investigator), Grudniewicz A (Principal Investigator), Goldsmith L (Principal Investigator), Burge F (Co-investigator), Gibson R (Co-investigator), Glazier R (Co-investigator), Hawrylyshyn S (Co-investigator), Hedden L (Co-investigator), Hernandez-Lee J (Co-investigator), Horrey K (Co-investigator), Joyce M (Co-investigator), Kiran T (Co-investigator), MacKenzie A (Co-investigator), Mathews M (Co-investigator), McGrail K (Co-investigator), McPherson C (Co-investigator), Mitra G (Co-investigator), Sampalli T (Co-investigator), Scott I (Co-investigator), Snadden D (Co-investigator), Tomblin Murphy G (Co-investigator), Wong S (Co-investigator), Blackie D (Collaborator), Brown K (Collaborator), Cramb L (Collaborator), McKinnon L (Collaborator
DESCRIPTION:
Rationale: Reports of patients’ difficulty finding a primary care provider and accessing primary care
services persist though there are more primary care physicians (PCPs) per capita than ever before in
Canada. Understanding and addressing this apparent gap between growing per-capita physician supply and unmet patient needs for care is an urgent priority for policymakers.
There is widespread speculation that the expectations and practice choices of early-career PCPs are
changing relative to previous cohorts, but little evidence to support or refute this claim. We know there have always been differences in practice between early-career and established PCPs, but not if differences are growing. PCPs overall, or early-career PCPs specifically, may be working less, choosing practice with a specialized clinical focus, or choosing walk-in clinic practice, locums, or hospitalist care, rather than comprehensive family medicine. However, most workforce planning models implicitly assume that practice patterns are homogenous across cohorts and static over time.
The overarching of this project is to inform primary care planning by addressing gaps in existing goal knowledge about changes within the primary care physician workforce.
Objectives
1) Identify what values and preferences, including attributes of clinical work as well as lifestyle and financial considerations, shape the intentions and choices of family medicine residents and early career PCPs.
2) Compare practice patterns among early-career (<10 years in practice) and established (10+ years) PCPs and determine if any changes over time reflect cohort effects (attributes unique to the most recent cohort of PCPs), or period effects (changes over time across all PCPs).
3) Using the evidence generated under Objectives 1 and 2, engage stakeholders (post-graduate medical residents, early career physicians, and primary care and health workforce policymakers) in discussions of practice options, implications for primary care supply, and promising targets for intervention.
Methods: We propose a mixed-methods research design in British Columbia (BC), Ontario (ON), and Nova Scotia (NS), provinces with variable policy environments for primary care and collectively over half of the Canadian population. To address Objective 1, we will conduct semi-structured in-depth interviews with family medicine residents and early-career PCPs and analyze survey data collected by the College of Family Physicians of Canada. We will address Objective 2 through quantitative analysis of administrative health data, linked within each province and with comparable analytic approaches across provinces. To address Objective 3 we will compare results from Objectives 1 and 2 with available practice models to inform a series of deliberative dialogues with residents, early-career physicians, and policymakers.
This project will produce a framework to understand practice choices, newSignificance and impact: measures for comparing practice patterns, and information necessary for planners to ensure adequate provider supply and patient access to primary care. It will inform what policy changes could alter physician practice choices, or compensate for changes in physician service delivery. Findings will be relevant to many jurisdictions that face similar challenges of primary care access and workforce planning. Approaches developed for cross-provincial analysis will build capacity for future research.
Transitions in Care (TiC) Study
Title: Assessing the effect of primary care models and access on unplanned, repeat hospitalizations across communities in Nova Scotia
Funding Agency: Canadian Institute of Health Research
Award: Operating Grant: Transitions in Care – Best and Wise Practices Grant
Date: March 2020 - February 2022
Amount: $99,987 (Canadian dollar)
Investigators: Kephart G (Principal Investigator), Marshall EG (Principal Investigator), McPherson C (Principal Knowledge User), Andrew M (Co-investigator), Edwards L (Co-investigator), Gibson R (Co-investigator), Mathews M (Co-investigator), Reid M (Co-investigator), Sampalli T (Co-investigator), Blackmore G (Co-knowledge User), Robinson A (Collaborator)
DESCRIPTION:
Significance and Impact: Unplanned, repeat hospitalizations (URH) result from, and contribute to, problems with care transitions. Poor access to and lack of comprehensiveness and integration of community-based support,
including primary health care, increase the risk of unplanned and avoidable hospitalizations. Primary health care
accessibility and comprehensiveness are thus expected to play a role in successful transitions from hospital to home
and in the prevention of repeat hospitalizations. Our team recently examined URH by the community to which (not the hospital from) patients were discharged, as a performance indicator of how well communities support transitions between hospital and community. We found substantial variation between communities in the case-mix adjusted risk of URH following discharge.
This study will estimate the role of primary care in accounting for community variation of URH. Understanding the role of accessible, comprehensive primary health care will facilitate the coordination of health and social services for patients and their families. It has the potential to play a central role at the community level in facilitating patient transitions and in preventing rehospitalization.
Models will compare community variation in the risk of URH, before and after adjustment for primary care
variables. This will assess the overall importance of primary care variables in accounting for community variation in
the risk of URH, and estimate the contribution of primary care variables to outcomes in individual communities.
Team Expertise and Feasibility: This study is partnered with knowledge users from government and the Nova
Scotia Health Authority to maximize the relevance, usefulness, and uptake of findings. Our interprofessional team
includes experienced health researchers and knowledge users. This study will build on existing methods and
datasets developed by the nominated and co-principle investigators (NPI and CoPI) to answer new questions about
transitions in care. Both the NPI and CoPI have extensive experience working with linked administrative data
through Health Data Nova Scotia.
Funding Agency: Canadian Institute of Health Research
Award: Operating Grant: Transitions in Care – Best and Wise Practices Grant
Date: March 2020 - February 2022
Amount: $99,987 (Canadian dollar)
Investigators: Kephart G (Principal Investigator), Marshall EG (Principal Investigator), McPherson C (Principal Knowledge User), Andrew M (Co-investigator), Edwards L (Co-investigator), Gibson R (Co-investigator), Mathews M (Co-investigator), Reid M (Co-investigator), Sampalli T (Co-investigator), Blackmore G (Co-knowledge User), Robinson A (Collaborator)
DESCRIPTION:
Significance and Impact: Unplanned, repeat hospitalizations (URH) result from, and contribute to, problems with care transitions. Poor access to and lack of comprehensiveness and integration of community-based support,
including primary health care, increase the risk of unplanned and avoidable hospitalizations. Primary health care
accessibility and comprehensiveness are thus expected to play a role in successful transitions from hospital to home
and in the prevention of repeat hospitalizations. Our team recently examined URH by the community to which (not the hospital from) patients were discharged, as a performance indicator of how well communities support transitions between hospital and community. We found substantial variation between communities in the case-mix adjusted risk of URH following discharge.
This study will estimate the role of primary care in accounting for community variation of URH. Understanding the role of accessible, comprehensive primary health care will facilitate the coordination of health and social services for patients and their families. It has the potential to play a central role at the community level in facilitating patient transitions and in preventing rehospitalization.
Models will compare community variation in the risk of URH, before and after adjustment for primary care
variables. This will assess the overall importance of primary care variables in accounting for community variation in
the risk of URH, and estimate the contribution of primary care variables to outcomes in individual communities.
Team Expertise and Feasibility: This study is partnered with knowledge users from government and the Nova
Scotia Health Authority to maximize the relevance, usefulness, and uptake of findings. Our interprofessional team
includes experienced health researchers and knowledge users. This study will build on existing methods and
datasets developed by the nominated and co-principle investigators (NPI and CoPI) to answer new questions about
transitions in care. Both the NPI and CoPI have extensive experience working with linked administrative data
through Health Data Nova Scotia.
The UP Study
Title: The lived experience of unattached patients in Nova Scotia: A mixed methods study
Funding Agency: Nova Scotia Health Authority Research Fund
Award: Operating Grant Category 2
Date: December 2016 - December 2018
Amount: $15,000 (Canadian dollar)
Investigators: Marshall EG (Principal Applicant), Andrew MK (Co-applicant), Burge F (Co-applicant), Edwards L (Co-applicant), Gibson R (Co-applicant), Lawson B (Co-applicant), MacKenzie A (Co-applicant), McIsaac K (Co-applicant), Sampalli T (Co-applicant), Stock D (Co-applicant)
DESCRIPTION:
The UP-Study collected qualitative inteview data with Nova Scotians who who experienced patient unattachment and were looking for a primary care provider. Key findings can be found in our publication, Marshall, E.G., Wuite, S., Lawson, B., Andrew, M.K., Edwards, L., MacKenzie, A., Woodrow, A.C., Peddle, S. What do you mean I can't have a doctor? This is Canada! - The myriad of consequences for unattached patients: health outcomes, mistrust, and strategic efforts to self-manage health and gain access to primary care. BMC Family Practice. Preprint DOI: https://doi.org/10.1101/2021.07.07.21260143 (In press)
Funding Agency: Nova Scotia Health Authority Research Fund
Award: Operating Grant Category 2
Date: December 2016 - December 2018
Amount: $15,000 (Canadian dollar)
Investigators: Marshall EG (Principal Applicant), Andrew MK (Co-applicant), Burge F (Co-applicant), Edwards L (Co-applicant), Gibson R (Co-applicant), Lawson B (Co-applicant), MacKenzie A (Co-applicant), McIsaac K (Co-applicant), Sampalli T (Co-applicant), Stock D (Co-applicant)
DESCRIPTION:
The UP-Study collected qualitative inteview data with Nova Scotians who who experienced patient unattachment and were looking for a primary care provider. Key findings can be found in our publication, Marshall, E.G., Wuite, S., Lawson, B., Andrew, M.K., Edwards, L., MacKenzie, A., Woodrow, A.C., Peddle, S. What do you mean I can't have a doctor? This is Canada! - The myriad of consequences for unattached patients: health outcomes, mistrust, and strategic efforts to self-manage health and gain access to primary care. BMC Family Practice. Preprint DOI: https://doi.org/10.1101/2021.07.07.21260143 (In press)
MAAP-NS
Title: MAAP-NS: Models and Access Atlas of Primary Care in Nova Scotia
Funding Agency: Nova Scotia Health Research Foundation; Canadian Institutes of Health Research (Knowledge Translation)
Award: NSHRF Establishment Grant and CIHR Knowledge Translation Grant
Date: January 2012 - January 2017 & January 2016 - July 2017
Amount: $150,000 (Canadian dollar) & $10,000 (Canadian dollar)
Investigators: Marshall EG (Principal Investigator), Burge F (Co-investigator), Chisholm J (Co-investigator), Gibson R (Co-investigator), Lawson B (Co-investigator),
DESCRIPTION:
https://www.dal.ca/maapstudy.html
The innovative Models and Access Atlas of Primary Care Providers in Nova Scotia (MAAP-NS) study used provider and practice surveys of all primary care offices, being the first to describe the constituent elements of their practice models, accessibility, and comprehensiveness. The surveys garnered exceptional response rates (85% of practices; 65% of providers). Linking to administrative billing data highlighted organizational reforms most successful in promoting equity and comprehensiveness outcomes. The MAAP-NS study, ($150k budget), yielded 8 publications and was an invited SAGE Research Methods Case (2020). MAAP has been well-received by researchers, providers, and policy makers, and replicated in other provinces, (PE, BC, AB, SK, NL), owing to my unwavering eagerness to share data collection instruments and collaborative spirit. (http://dal.ca/maapstudy; https://maap-bc.ca/).
Funding Agency: Nova Scotia Health Research Foundation; Canadian Institutes of Health Research (Knowledge Translation)
Award: NSHRF Establishment Grant and CIHR Knowledge Translation Grant
Date: January 2012 - January 2017 & January 2016 - July 2017
Amount: $150,000 (Canadian dollar) & $10,000 (Canadian dollar)
Investigators: Marshall EG (Principal Investigator), Burge F (Co-investigator), Chisholm J (Co-investigator), Gibson R (Co-investigator), Lawson B (Co-investigator),
DESCRIPTION:
https://www.dal.ca/maapstudy.html
The innovative Models and Access Atlas of Primary Care Providers in Nova Scotia (MAAP-NS) study used provider and practice surveys of all primary care offices, being the first to describe the constituent elements of their practice models, accessibility, and comprehensiveness. The surveys garnered exceptional response rates (85% of practices; 65% of providers). Linking to administrative billing data highlighted organizational reforms most successful in promoting equity and comprehensiveness outcomes. The MAAP-NS study, ($150k budget), yielded 8 publications and was an invited SAGE Research Methods Case (2020). MAAP has been well-received by researchers, providers, and policy makers, and replicated in other provinces, (PE, BC, AB, SK, NL), owing to my unwavering eagerness to share data collection instruments and collaborative spirit. (http://dal.ca/maapstudy; https://maap-bc.ca/).
CARE BY DESIGN
Title: Improved outcomes with a new model of dedicated primary care physician and team approach for long-term care facilities? A mixed-methods study
Funding Agency:
Dalhousie University Department Family Medicine Research Award
Amount: $20,000 (Canadian dollar)
Canadian Institutes of Health Research (CIHR) (June 2010 - June 2011)
Award: Network for End-of-Life Studies - ICE Grants
Amount: $5000 (Canadian dollar)
Capital District Health Authority (CDHA) (Nova Scotia) (June 2010 - June 2011)
Office of the Director of Continuing Care
Amount: $34,000 (Canadian dollar)
Capital District Health Authority (CDHA) (Nova Scotia) (June 2010 - June 2011)
Award: Capital Health Research Fund
Amount: $50,000 (Canadian dollar)
Investigators: Marshall EG (Principal Investigator), Andrew M (Co-investigator), Archibald G (Co-investigator), Burge F (Co-investigator), Clarke B (Co-investigator), Edgecombe N (Co-investigator), Jensen JL (Co-investigator), Taylor A (Co-investigator), Travers A (Co-investigator), MacLeod G (Collaborator)
DESCRIPTION:
The findings of the Care by Design Study informed decision-makers on reduced ED transports and polypharmacy with concurrent increased continuity of care and satisfaction with the new model. This work, presented locally, nationally and internationally, contributed to a designation of “Leading Practice” by Accreditation Canada, and 10 peer reviewed journal publications.
Funding Agency:
Dalhousie University Department Family Medicine Research Award
Amount: $20,000 (Canadian dollar)
Canadian Institutes of Health Research (CIHR) (June 2010 - June 2011)
Award: Network for End-of-Life Studies - ICE Grants
Amount: $5000 (Canadian dollar)
Capital District Health Authority (CDHA) (Nova Scotia) (June 2010 - June 2011)
Office of the Director of Continuing Care
Amount: $34,000 (Canadian dollar)
Capital District Health Authority (CDHA) (Nova Scotia) (June 2010 - June 2011)
Award: Capital Health Research Fund
Amount: $50,000 (Canadian dollar)
Investigators: Marshall EG (Principal Investigator), Andrew M (Co-investigator), Archibald G (Co-investigator), Burge F (Co-investigator), Clarke B (Co-investigator), Edgecombe N (Co-investigator), Jensen JL (Co-investigator), Taylor A (Co-investigator), Travers A (Co-investigator), MacLeod G (Collaborator)
DESCRIPTION:
The findings of the Care by Design Study informed decision-makers on reduced ED transports and polypharmacy with concurrent increased continuity of care and satisfaction with the new model. This work, presented locally, nationally and internationally, contributed to a designation of “Leading Practice” by Accreditation Canada, and 10 peer reviewed journal publications.