Evaluation

Advancing Health evaluation experts are leading a developmental evaluation in partnership with the Matsqui-Abbotsford Impact Society to support the implementation and adaptive development of its Nation of Wellness (NoW) initiative. NoW is a youth-led, adult-trusted initiative creating spaces of trust where youth and young adults (aged 14–28) guide and support their communities to build a culture where young people (especially those with experience of marginalization) are seen, heard, included, and celebrated. The evaluation will serve as a mechanism for guiding Impact, the NoW Steering Committee, and their partners to establish and clarify the processes, methods, and evidence needed to understand how the initiative is taking shape, and assist leaders in defining what formative and summative indicators they will use to navigate the uncertainties and emerging challenges they face when implementing NoW.

Advancing Health evaluation experts are conducting a principles-focused developmental evaluation of the Megamorphosis Project in Long-Term Care at Providence Health Care.

Megamorphosis recognizes the need to transition to a more socially vibrant, relationship-centred care model that recognizes the uniqueness of each individual and the importance of significant relationships and interdependent relationships that have been or can be developed with people living with dementia. The program’s three guiding principles are: emotional connections matter most, residents direct each moment, and home is not a place, it is a feeling. Through the evaluation, the theoretical underpinnings of this model and how it may improve clinically and quality of life outcomes for residents and the experience of families and health workers will be established.

The Dementia Village project is being implemented by Providence Living (PL) and Island Health (IH) to completely reimagine long term care living. This innovative project aims to do this by creating an environment that readily engages residents and strengthens a sense of connection with the broader community while transitioning the care model to a social model that recognizes residents’ biography, encourages vibrant relationships, and fosters a sense that life continues to have value and purpose. Advancing Health evaluation experts are conducting a principles-focused developmental evaluation of the Dementia Village project to document and inform key decisions on the ongoing development of the project, examine the context associated with the implementation of the project, and assess the effect of the Dementia Village on the quality of life of residents, their families and visitors, and health workers.

This project aims to create a conceptual evaluation framework to determine indicators to monitor and evaluate patient and family caregiver engagement in decision making in healthcare systems. Dr. Snow is working with colleagues from Fraser Health, the Ministry of Health, the BC Patient Safety Quality Council, and other organizations on this project.

• NPI: Dr. Jessica Moe, UBC and BCCDC
• PIs: C. Davidson (BC MoH), J. Buxton (UBC, BCCDC), A. Salmon (UBC, Advancing Health), A. Slaunwhite (Advancing Health, BCCDC)

During the COVID-19 pandemic, British Columbia (BC) has seen a tragic increase in drug overdose deaths, due to a toxic drug supply, people using drugs alone, and difficulty accessing harm reduction services. Overdose prevention services (OPS), where people can use drugs in an observed setting, have struggled to meet physical distancing rules, and visits to OPS sites have fallen by 35% since COVID-19 began. At the same time as this recent spike in fatal overdoses, more people have been dying from smoking drugs in BC since 2016. Many people think that their risk of having an overdose is lower if they smoke opioids than if they inject, but this is not actually true. Also, it is more difficult for people who smoke drugs to use OPS, because many sites do not allow smoking, or if they do, have smoking areas outside that are hard for staff to monitor. During COVID-19, there has been a greater drop in people coming to OPS to smoke drugs than to use drugs in other ways, in part because OPS is not set up well to meet the needs of people who smoke. This study will introduce continuous oxygen monitoring at partnering OPS for people who come to smoke opioids or “down.” The team will train peer researchers at these sites to enroll participants, and to gather information from them. While smoking opioids, participants will attach a wrist monitor that will read and transmit their oxygen levels to iPads available to OPS staff. The team will train OPS staff to check on participants if their low oxygen levels trigger an alarm. They will also examine whether people who smoke drugs and OPS staff find the continuous oxygen monitoring protocol useful. The team will also look at how and when oxygen levels change when people smoke opioids. The findings will be used to develop harm reduction messaging for people who smoke drugs, to expand monitoring to other OPS and private locations like supportive housing across BC, and to develop oxygen monitoring apps that allow people who use drugs alone to do so more safely.

Read more about this project in this Government of Canada news release.

• NPI: Dr. Amanda Slaunwhite, Advancing Health, BCCDC
• PIS: PIs: B Nosyk, N Hongdilokkul, P Pauly, K Urbanowski

The COVID-19 pandemic is occurring alongside the overdose public health emergency in British Columbia (BC) with one escalating the harms of the other. The dual public health emergencies have necessitated the development and implementation of innovative response efforts to promote physical distancing and also mitigate the secondary effects of public health measures on persons who use substances (PWUS). This mixed-method study is investigating the efforts introduced to reduce COVID-19 infection among PWUS including the prescription of pharmaceutical alternatives (PALS) for opioids, stimulants, benzodiazepines, and other drugs. Administrative health data in combination with survey and interview data collected from PWUS and health care providers will be used to 1) Determine the impact of PALS on COVID-19 infection; non-fatal/fatal overdose; and continuity of care for substance use disorder and concurrent health conditions among PWUS; 2) Articulate how PALS has affected the uptake of physical distancing and other public health measures introduced to reduce the spread of COVID-19 (e.g., mask-wearing, hand washing, self-isolation); 3) Identify barriers and facilitators to PALS implementation based on program uptake and the perspectives of PWUS, outreach workers, prescribers, and other stakeholders. This project will focus on assessing the effects of risk mitigation efforts on PWUS with an emphasis on First Nations peoples, persons with criminal justice system involvement, and pregnant women. PWUS are more likely to have risk factors for severe acute respiratory syndrome and experience homelessness and income insecurity. This project will provide critical evidence to inform pandemic planning and emergency response activities at federal, provincial, and local levels, as well as the expansion of PALS in other Canadian provinces, and the upcoming flu season. Dr. Amy Salmon, Program Head for Knowledge Translation at CHÉOS, is a co-investigator on this study representing the Fraser East Overdose Response Project.

• NPI: Dr. Jagbir Gill (UBC, Advancing Health)

Kidney transplantation is the best treatment for patients with kidney failure because it helps patients live longer and have a better quality of life compared to dialysis. Transplantation also reduces health care costs, since each year of dialysis costs roughly $50,000 for each patient with kidney failure. Living donor kidney transplantation, where someone who is alive donates a kidney to a friend or loved one, is the fastest way to get a transplant and results in the best outcomes. People with kidney failure who live in rural, remote, or Indigenous communities are less likely to get a kidney transplant and it takes longer for them to get a transplant, meaning they spend more time on dialysis. In this study, we will implement and test the impact of a new program where directed support and education will be provided in rural, remote, and Indigenous populations in BC to help patients with kidney failure get improved access to living donor kidney transplantation, by helping them find potential living kidney donors and by speeding up their work-up for transplantation by minimizing travel to and from the transplant program in Vancouver. This program aims to result in more kidney transplants for patients in rural, remote, and Indigenous populations in BC and therefore result in better outcomes for these patients. Dr. Amy Salmon and staff members from the Advancing Health Program Evaluation and Knowledge Translation teams provide support for study design, data collection and analysis, and knowledge translation.

• NPIs: Dr. Istvan Mucsi (University Health Network) and Dr. Jag Gill (PHC, Advancing Health)

The A.C.T.I.O.N. study aims to reduce inequities in access to living kidney donation and transplantation (LDKT) in the South Asian and Black, African and Caribbean (ACB) communities in British Columbia and Ontario. LDKT is the preferred treatment for patients with kidney failure because it provides better health outcomes than dialysis and lasts longer than a kidney from a deceased donor. Access to LDKT is dramatically reduced among ethno-racial minority groups in Canada, with some studies reporting a 50–70% lower likelihood of transplantation in Indigenous and ACB populations. Culturally and linguistically competent education and other supports to help patients with end-stage kidney disease identify potential living donors have been found to increase LDKT in ethno-racial minority groups in the UK, the Netherlands, and the US. No such interventions targeting ethno-racial minority groups have been carried out in Canada. The A.C.T.I.O.N. project will address this gap by identifying barriers to access and piloting interventions to reduce inequities in access to living donation and transplantation in two large and diverse communities. Lessons learned from the project will inform efforts to improve access and equity in living donation and transplantation in racialized communities across Canada. Dr. Amy Salmon and staff members from the Advancing Health Program Evaluation and Knowledge Translation teams provide support for study design, data collection and analysis, and knowledge translation.

• Clinical & Systems Transformation (CST) Project

British Columbia’s Clinical & Systems Transformation (CST) Project is a joint undertaking between Vancouver Coastal Health, the Provincial Health Services Authority, and Providence Health Care to improve patient care by making sure that their practices are evidence-based and consistent across clinical areas, and are supported by smarter technology including electronic health records. Dr. Beth Snow led the CST Evaluation, which evaluated the impact of the CST project and identifies opportunities for further improvement for the first five years of the project.

• Health Supports for Youth: Foundry

Advancing Health Scientist Dr. Steve Mathias is leading this provincial initiative, which provides low-barrier access to primary care, mental health, substance use, and social supports to youth aged 12 to 24. The “proof of concept” phase initially established five new Centres—one for each regional health authority, plus the already established Granville Youth Health Centre. Dr. Amy Salmon was the Developmental Evaluator for Foundry, and Dr. Chris Richardson assisted with the development of Foundry’s data platform. Learn more at https://foundrybc.ca/