Patient Engagement in Health Economics

Improving Efficiency and Resource Allocation for Cancer Care through Patient Engagement in Economic Evaluations: A Case Study of CAR-T Therapies.

While patient engagement has become much more common in recent years, particularly in clinical (human) research, less is known about how patients and the public can be involved in more technical aspects of research such as economic evaluations. Our project seeks to fill this gap by first improving the understanding of patient engagement in previous economic evaluations. To do so, we will perform an exploratory review of existing scientific and public literature to describe how patients have previously been engaged in the development and conduct of economic evaluations of care for cancer. We will then use moderated group discussions with persons affected by cancer (focus groups) to identify key barriers and enablers to engaging patients and the public in health economic research of cancer and to find ways to improve how patients are involved in this research. Working with our patient partners, we will develop future funding applications to put together a set of recommendations for involving patients and caregivers in economic evaluations of cancer care. 

Funding: Ontario Institute Cancer Research (OICR)/ BioCanRx and Ontario SPOR SUPPORT Unit (OSSU).

Understanding preferences for substance use health services for problematic alcohol use during the COVID-19 pandemic

This study will describe preferred characteristics of substance use health services for problematic alcohol use (PAU) and assess how the COVID-19 pandemic may affect their preference and also assess the relative importance of the characteristics of substance use health services for PAU. Following a mixed methods approach, a scoping review and qualitative research methods will be utilized identify preferred characteristics of substance use health services for PAU. A discrete choice experiment survey will be conducted to elicit the preference for such services.

Funding: Canadian Institutes of Health Research

Early Economic Evaluations

Microbiome-Based Precision Medicine in Inflammatory Bowel Disease

Using genomics, this project seeks to delve into the intricate microbial alterations unique to patients with Inflammatory Bowel Disease (IBD). By gaining insights into these specific changes, the research aims to pave the way for the development of rapid and non-invasive diagnostic tests. These personalized tests will enable healthcare providers to customize treatment plans according to each patient's distinct disease profile, offering a significantly faster and more effective approach to managing IBD compared to conventional methods. The ultimate goal is to revolutionize IBD care, empowering medical professionals with precision medicine tools that improve patient outcomes and quality of life while potentially reducing the overall burden of the disease on healthcare systems and society as a whole.

Funding: Genome Canada

Economic Evaluations of Health Care Interventions

Health System Costs of HIV/AIDS and an Economic Evaluation of Innovative Implementation Strategies for HIV Self-testing

HIV care has evolved rapidly over the past decade, leading to improvements in healthcare services, healthcare use, and health outcomes among people living with HIV in Ontario. Studies on the healthcare costs related to HIV in Canada are scarce and few correspond to current care practices. Our retrospective cohort study uses Ontario administrative health data housed at ICES (formerly known as the Institute of Clinical Evaluative Sciences) to: 1) estimate the total and attributable healthcare utilization costs for HIV among adults in Ontario and 2) to estimate the healthcare costs associated with missed opportunities for HIV diagnosis in Ontario. Study findings can help inform budget and resource allocation for healthcare services for people living with HIV. In doing so, findings have the potential to facilitate improvements in policies, practices, and services for people living with HIV, providing more effective and efficient access and uptake of HIV prevention and care, and improving health at the individual and population level.

Funding: CIHR - HIV/AIDS Biomedical and Clinical Research – Team Grant

Health Services Research

Validation and optimization of sepsis case definition utilizing ICD-10-CA codes and antimicrobial usage data in health administrative data

Administrative health data are widely used in health research. Recent studies evaluating the performance of algorithms used to define and identify sepsis in administrative data show that it is under coded.  The addition of pharmacy data, specifically antimicrobial usage data to existing algorithms has been suggested as a means to improve the accuracy of sepsis identification algorithms.  The goal of this study is to optimize and validate this strategy by manual review of a random sample of Intensive Care Unit (ICU) patient charts to classify these patients as having sepsis during their ICU admission or not. After classification, the existing sepsis identification algorithm is applied. A modified version of the algorithm, which includes additional information on antimicrobial usage is also developed and applied, and its performance evaluated in comparison to the existing algorithm.

Funding: The Ottawa Hospital Academic Medical Organization (TOHAMO) Innovation Fund Grant

Developing Federated Learning Strategies for Disease Surveillance Using Cross Jurisdiction Electronic Medical Records without Data Sharing: With Applications to Acute Myocardial Infarction, Hypertension, and Sepsis Detection

Health research across the provinces and territories requires the sharing of Electronic Medical Records (EMRs). The sharing of data across jurisdictions is difficult due to system governance, architecture, and data security regulations. Federated Learning Strategies is a new method for computer models to collaborate without centralizing the data or exchanging data among clients, such as hospitals. Acute myocardial infarction (AMI) is an acute, life-threatening condition associated with high mortality and hospital readmissions after discharge. Hypertension is one of the most common chronic conditions in the general population. Sepsis, a syndrome of severe infection causing organ failure, is a major worldwide health problem, without a standard definition. Our project will develop a novel Federated Learning framework for disease surveillance, with applications to the detection of AMI, hypertension, and sepsis, using electronic medical record data across multiple provinces in Canada without data sharing.  

Funding: CIHR

The impacts of the COVID-19 pandemic on patient distribution, service utilization, outcomes, hospital costs and revenue, and staff experience at The Ottawa Hospital

To describe the variation across the Ottawa Hospital departments in terms of service utilization (visits, admissions, diagnostic and imaging procedure use, therapeutic and preventive care use), hospital costs and revenue, and staff experience (absenteeism and turnover) over the COVID-19 pandemic waves; 2. To evaluate whether the COVID-19 pandemic affected service utilization, costs and revenue, and staff experience by comparing these outcomes measured before the COVID-19 pandemic time period with those observed from the previous two years to identify patterns of variation

Funding: The Ottawa Hospital Foundation