Funded project targets ‘high-needs, high-cost’ patients with precision public health

Academic researchers are no strangers to rejection. Having a project rejected once, twice, even five times is not uncommon — which is why when Dr. Paul Ronksley, PhD, received a notice of funding rejection for a project to address the health-care system’s “high-needs, high-cost” patients, he got to work anyway.

“I was going to do this work because it's important, regardless whether it got funded or not,” says Ronksley. “I knew I would re-apply, but wasn’t going to sit around waiting until that happened.” 

• Photo above: A CIHR funded project led by Dr. Paul Ronksley, PhD, aims to improve the quality and sustainability of care for high-user patients in Alberta. Photo by Brittany DeAngelis 

After that initial rejection, Ronksley now has his chance. His was one of seven projects led by O’Brien Institute for Public Health members that were funded through the CIHR Fall 2019 Project Grant competition. 

Making the right intervention at the right time

Ronksley is working with the Strategic Clinical Networks (SCNs) within Alberta Health Services to develop a roadmap to help decision-makers identify the right intervention for the right population at the right time. As part of the project, he will also work with the SCNs to test interventions that have worked in other jurisdictions and tailor them to the Alberta context.

It’s well known that five per cent of the population use 65 per cent of health-care resources, and decision-makers continue to struggle to find ways to improve care in this diverse population while also addressing rising health-care spending.

“This is a unique opportunity to leverage the strengths of our health-care data within Alberta but also the strengths of the Strategic Clinical Networks to tackle a key problem within our health system,” says Ronksley, who is an associate professor in the Department of Community Health Sciences at the Cumming School of Medicine (CSM).

'One size does not fit all'

The opportunity to improve the quality and sustainability of care for this high-risk population is an exciting one for the province, says Dr. Braden Manns, MD, associate chief medical officer with Alberta's SCNs and a member of the O’Brien Institute and the Libin Cardiovascular Institute at the CSM.

“One size does not fit all in the planning of health interventions,” he says. “If we're going to improve patient outcomes while bending the cost curve, we must proactively address the needs of these complex patients in an effective way.”

The O’Brien Institute for Public Health recipients of CIHR Project Grant funding are:

• Dr. Claire Barber, MD: “Understanding the Effect of Adherence to System-Level Performance Measures on Outcomes for Rheumatoid Arthritis”

Dr. Barber, O’Brien Institute and McCaig Institute for Bone and Joint Health member, is investigating how better quality of care effects rheumatoid arthritis (RA) patient outcomes and the health-care system using performance measures developed by the Arthritis Alliance of Canada. The aim is to enable health systems to improve so that patients living with RA can get the best possible care and achieve the best possible health outcomes. More project details here.

• Dr. Mingshang Lu, PhD: “The Costs and Benefits of Transitioning from ICD-10-CA to ICD-11 in Canada”

The International Classification of Disease (ICD) is a system used worldwide to track disease and morbidity. The World Health Organization (WHO) has recently released the 11th version of ICD, and the transition from ICD-10 to ICD-11 is underway globally. In Canada, urgent questions have arisen about the costs and benefits of transitioning to ICD-11 from decision-makers and health information management. A project led by O’Brien Institute member Mingshang Lu aims to provide an evidence-based financial estimate of transitioning to ICD-11 through the use of a specially designed framework and calculation tool. 

This project will provide critical information for countries worldwide to prepare for ICD-11 adoption. More project details here.

• Dr. Katrina Milaney, PhD: “Implementation and Evaluation of an Indigenous-Specific Managed Alcohol Program for the Homeless Indigenous Population in Calgary, Alta. and Victoria, B.C.”

Indigenous peoples are disproportionately represented in the homeless population. Those with substance dependency are especially vulnerable — susceptible to violence, premature death, and a vicious cycle of hospitalization, emergency shelter use, and incarceration.

Dr. Milaney is working with Indigenous community partners and leaders to co-create a managed alcohol program that supports Indigenous peoples living in Calgary and Victoria who struggle with homelessness and severe alcohol use disorder. More project details here.

• Dr. Ken Kuljit Parhar, MD: “Minimizing Variation In Care Among Critically Ill Patients With Respiratory Failure Through Implementation Of An Evidence-Informed Care Pathway”

Dr. Parhar is working to improve outcomes for patients with severe lung failure through improved diagnosis and treatment. Lung failure can be caused by severe infections such as pneumonia and is a common reason for patients to be admitted to the intensive care unit.

Treatments such as using the breathing machine carefully, using medications to help relax the chest muscles, and ensuring the patient is positioned correctly, have been shown to save lives. Parhar is working with care providers, including nurses, respiratory therapists, and physicians, as well as patients and their families to increase the use of these methods to ensure the right patients get the right treatment at the right time. More project details here.

• Dr. Prism Schneider, MD: “Quantification of the Duration of Increased Risk for Venous Thromboembolism in Patients with Femur Fractures Using Thrombelastography”

A study led by Dr. Schneider, O’Brien Institute and McCaig Institute for Bone and Joint Health member, will test if Thrombelastography (TEG) technology, which uses a small sample of blood to evaluate a person's risk for blood clots, can also determine how long each patient should receive medication to minimize their clot risk after surgery to treat femur fractures.

The results from the study will also help identify factors that increase both abnormal bleeding and increased clotting risk and will help develop protocols to minimize this risk. More project details here.

• Dr. Karen Tang, MD: “Development of a Typology for Patient Navigation: Defining the Essence of a Complex Intervention”

Patients often need to navigate a confusing and overwhelming health-care system. “Patient navigation” was created to assist with this, but despite a rapid increase in these programs, and the services they provide, what patient navigation even means is unclear.

Researchers led by O’Brien Institute member Dr. Tang are working to create a typology, or classification framework, to better understand patient navigation, and what lies at the heart of this complex intervention. This work will form an evidence-based, patient-centred foundation so that, for the first time, best practices and standards can be established in this field. More project details here.