Grant: Foundation Grant

Epidemiologic Methods; Health Administrative Data; Health Systems Research; High-Cost Healthcare Users; Hospital Profiling; Longitudinal Cohort Studies; Multiple Chronic Disease; Statistical Modeling

<html> <body> <p>Health system reform in Canada is focused on integrating health systems for managing high need patients. High need patients are those with multiple complex chronic conditions, mental illness, functional impairment or a combination of these conditions; they account for the majority of health care spending. Integrated networks are groups of providers that deliver coordinated services to a defined population and are held clinically and fiscally accountable for the health outcomes of the population.<br> <br> Through a CIHR Team grant, I identified informal, multispecialty physician networks in Ontario (that mimic integrated systems) consisting of patients and the physicians and hospitals that deliver the majority of their care, and developed a set of quality indicators to measure system performance across the continuum of care. Directly informed by these concepts, the Ontario Ministry of Health (MoH) adopted Health Links (HL), an initiative to create integrated systems to improve care for high need, high cost patients. Health Links are variably structured and while they are not identical to our networks, they align closely especially in non-urban areas.<br> <br> My program of health systems research will measure and evaluate the performance of integrated health systems to provide rigorous evidence to stakeholders in developing strategies that improve care and care delivery in Ontario and other jurisdictions. The work will consist of a series of interrelated studies focusing on identifying and improving the care of high need patients, investigating system characteristics associated with high performance, equity and efficiency; providing tools for profiling integrated health systems, and engaging with Ontario knowledge users from Health Quality Ontario (HQO) to evaluate and monitor integrated health systems.<br> <br> The approach involves a collaborative effort to define high need patients; describe variations in their quality and costs of care across integrated networks (Health Links); refine our quality indicators to be relevant to the population of high need patients; aggregate the quality measures into discrete domains to provide stable, interpretable results; analyze the indicators with a view to equity across networks; continue to investigate system characteristics associated with high performance, especially markers of system integration; explore characteristics of efficient systems that exhibit higher quality and lower costs; and implement advanced statistical methods for profiling systems with respect to readmissions or outcomes that are relevant to patients. Statistical methods include longitudinal cohort analyses, empirical Bayes random-effects models, and instrumental variable (IV) models.<br> <br> I have led this collaborative group for the past 6 years as PI of a CIHR Team grant. We have the appropriate mix of methodological and clinical expertise in health services and health policy research and excellent collaborations with knowledge users from Health Quality Ontario to undertake this work. We will build capacity by mentoring students and junior faculty by inviting them to participate in our collaborative work, including a promising post-doctoral fellow and a New Investigator, and building a strong interdisciplinary team of senior and junior researchers.<br> <br> Research of this scope has not been done before in Canada or internationally so this will fill a major gap in health systems research on high need patients in integrated delivery systems.</p> </body> </html>