The NB PIHCI Network has been successful in securing funding for important demonstration projects under the CIHR Quickstrike initiative (referred to as QSI and II).
These projects were designed to support rapid-turn around, time sensitive, cross-jurisdictional research.
QSI was led by a team of two NB principal investigators, Drs. Shelley Doucet and Rima Azar, and Dr. William Montelpare in PEI. This project defined children with complex health conditions and explored the needs of these children and their families. The team also identified the services/programs available via literature scans and interviews with children, families, and stakeholders. The team created a tool to identify and classify complex health conditions in child patients.
QSII, led by Drs. Carole Trachant and Mathieu Belanger in NB and in partnership with Dr. William Montelpare in PEI, will identify and evaluate selected administrative datasets from the two provinces in order to: 1) create intra-provincial health profiles of 18-month-old children and 2) establish the foundation for a birth cohort database in NB and PEI. The outcomes will yield helpful insights into children’s health status that can be used toward chronic disease prevention.
The two QS projects have enabled NB to build a foundation of identifying and providing long-term follow-up for children with complex needs. Embedded in these projects is the goal of identifying gaps in the current system across jurisdictions and how best to serve these children. Both projects also identify challenges in the social and health systems. Additionally, both projects incorporate patients and caregivers at all levels of decision making.
Additional demonstration projects will address a second important stream of research: complex needs across the lifespan. Dr. Shelley Doucet and Dr. Rima Azar, have joined a Quebec-led Comparative Policy Analysis grant that will describe new and emerging integrated service delivery models that connect health and social services in Canada. This initiative will enlist the help of post-doctoral students who are also NB PIHCI stakeholders.
NaviCare/SoinsNavi: New Brunswick Navigation Centre for Children with Complex Care Needs
Dr. Shelley Doucet is a Co-Principal Investigator with Dr. Rima Azar from Mount Allison University on a project that was funded through the New Brunswick Children’s Foundation to develop a navigation centre in New Brunswick for children with complex care needs.
The primary aim of the centre is to help facilitate more convenient and integrated care to support the physical, mental, emotional, and social needs of the children and their families. Children are assigned a patient navigator – a role that is relatively new in Canada. The patient navigators, one a registered nurse and the other a lay navigator, help families coordinate access to appropriate services and resources for their children. In addition, they act as a resource for the child’s care team, ensuring that the care remains integrated.
The services offered are based on a needs assessment conducted by our team in 2015-2016, which involved over 120 interviews with children and their families as well as with health, social, and educational stakeholders. Our team also did multiple site visits with navigation programs across North America and conducted an environmental scan of services available for children with complex health conditions in NB and in PEI.
To help ensure that NaviCare/SoinsNavi meets the needs of children and families, we have a Family Advisory Council, which includes five volunteers. These are parents of children with complex care needs or youth/young adults who have experienced growing up with a complex care needs. They meet monthly or as needed to advise the research team, our staff and the Patient Navigators.
SPOR PIHCI Programmatic Grant: Case Management in Primary Care for Frequent Users of Healthcare Services with Chronic Diseases and Complex Care Needs: Implementation and Realist Evaluations
The goals of this project are to: 1) generate findings on the implementation of case management in primary care for individuals with chronic conditions and complex healthcare needs who frequently use healthcare services; and 2) implement an evidence-based case management intervention that will improve care experiences and outcomes, and reduce the use of healthcare services by these individuals and the related costs. Individuals with chronic conditions and complex healthcare needs require a range of services from various systems (e.g. health, social, education) and community networks. This often leads to difficulties with the integration of care. These individuals are at greater risk for disability, reduced quality of life, and increased mortality.
Case management (CM) is a collaborative approach used to assess, plan, facilitate, and coordinate care to meet patient and family healthcare needs. This is achieved through communication and coordinating access to available resources and services across all levels of health care (such as community, primary, secondary and tertiary care), as well as sectors outside of the health system (such as social services, housing, etc.), with the intent to improve individual and health system outcomes. Implementation of CM directly within primary care settings fosters close interactions between the individual/patient, the Case Manager and the primary care team. Members of our research team have implemented and evaluated CM in Quebec primary care clinics over the past five years. Patients and their families have reported a positive experience regarding care integration. This intervention is rarely implemented in primary care across Canada. For CM to become standard practice in primary care in different jurisdictions, stakeholders including patients need to be engaged in adapting the intervention to their own context. Therefore, further research is required to better understand the facilitators and barriers of CM implementation in primary care, including the influence of different provincial primary care contexts on outcomes (e.g. self-management, quality of life, services integration, services use, and costs).
This project aims to address this gap by implementing the CM model in ten primary care practices, with two practices in each of the partnering provinces (QC, NB, SK, NL, and NS). In NB, we will be implementing the CM model in two pediatric clinics, one in Horizon Health Network and the other in Vitalité Health Network. Results will provide a detailed and highly practical understanding of CM that will be invaluable to plan and implement CM at local, regional, and national levels, towards a more effective, integrated, and efficient healthcare structure that supports better experience and improved care.
SPOR PIHCI Comparative Program and Policy Analysis Grant
Our SPOR Quick Strike research team partnered with stakeholders across Canada in 2016 to conduct a Comparative Policy Analysis that was funded through CIHR and matching partners. Our team is engaged in comparing current programs and the structures and policies in Canadian provinces and territories that govern primary health care, community-based social services, public health and community supports required for children and seniors, namely children/youth with high functional needs and community-dwelling older adults experiencing functional decline. I lead the research on children/youth.
SPOR PIHCI Knowledge Synthesis Grant Comparative: Interventions to support transitions in care for children and families with complex health care needs in the community
Children and youth with complex health care needs have a variety of conditions that range from less severe to life-threatening or life-limiting. For example, some children depend on medical devices and technologies whereas others require less intensive supports to live, work, and play in community settings. These children and youth experience many transitions, moving across stages of their conditions, from childhood to adulthood, between care settings, or from hospital to home/school or vice versa. Transitions are often challenging not only for children, but also for their families and care providers.
In this one-year project, we will conduct a review of the literature to shed light on interventions that support transitions in care occurring from: 1) diagnosis to age 19 years; and 2) pediatric to adult care, for youth aged between 14 and 25 years of age. Findings from our project, which are in line with primary care priorities established by NB, NS, PEI, and NL, will lead to recommendations for policy and practice, and will inform future research to support transitions in care for children with complex health care needs and their families. At the heart of this proposal are patients who will have a meaningful role in the project’s design and implementation. Other members of the research team include researchers, clinicians, librarians, policy makers, and community members across the Atlantic provinces and beyond.