Research

M-THAC Builds Influential Research Infrastructure

From Medicare to Home and Community Research Unit (M-THAC) is a Community Alliance for Health Research funded by the Canadian Institutes for Health Research (CIHR) and the Social Sciences and Humanities Research Council (SSHRC) and based out of HPME. Under the leadership of co-Principle Investigators, Raisa Deber and Paul Williams, M-THAC has developed an infrastructure for research on the implications of the shift in health care delivery to the home and community for providers, consumers and governments. Now at the midway point in its five-year term, we take this opportunity to review its achievements and future goals.

Research and Training Infrastructure

Since 2001, M-THAC has grown to include 39 members and over a dozen national, provincial and local associations, regulatory bodies, agencies and industry partners. The research unit has evolved into a network of partnerships among multi-disciplinary academic and community-based researchers, decision-makers and practitioners. M-THAC is also home to 19 fellows. It provides seed funding to researchers and trainees through the Opportunities Fund, which will cover such costs as printing and mailing questionnaires, long distance charges for conducting telephone interviews, obtaining statistical consultation, conducting field research and presenting papers on the results of M-THAC research. The Student Research Assistance Fund is designed to further student training by awarding funds for approved research projects to assist trainees and the researchers who work with them. Competitions are held quarterly (next deadline: October 15, 2004).

Funded Projects

The M-THAC Research Unit funds and oversees 33 projects. Some of these include:

• Almost Home: Reforming Home and Community-Based Care in Ontario
• Boundaries of Medicare
• Estimating Operational Efficiencies of LTC facilities in Ontario
• Public and Private in Financing and Delivery
• Exploring Alternative Funding Models for Canadian Health Care

Research Products

M-THAC researchers and fellows have generated numerous working papers and publications, including the newly-released book:

• Almost Home: Reforming Home and Community Care in Ontario, by Patricia Baranek, Raisa Deber and A. Paul Williams. University of Toronto Press, October 2004.

Other recent publications include:

• “What's In” “What's Out” Stakeholders' Views About the Boundaries of Medicare by Raisa Deber and Brenda Gamble (fellow). Pre-Released Paper in Longwoods Review Vol 2, No 3, 2004.
• Cats and Categories: Public and Private in Canadian Healthcare, by Raisa Deber. Healthcare Papers Vol 4, No 4 2004
• Is Canada's health care system really 30th in the world? An article by Raisa Deber explains how the World Health Organization derived those rankings, and why not to place too much credence in it. Longwoods Review, Vol 2, No 1, 2004.
• Medical Savings Accounts: Will They Reduce Costs?, by Evelyn Forget, Raisa Deber and Leslie Roos. Canadian Medical Association Journal 167(2): 143-147, 2002. A preliminary publication examining Medical Savings Accounts clarifies that these will not save costs.
• Delivering Health Care Services: Public, Not-for-profit or Private. Discussion Paper No. 17. Commission on the Future of Health Care in Canada. By Raisa Deber, August 2002. One of 40 discussion papers submitted to the Romanow Report by health researchers and experts from across Canada.

For information on becoming an M-THAC partner, researcher or fellow, see the members page on the M-THAC website or contact Cathy Bezic, M-THAC Coordinator, at cathy.bezic@utoronto.ca .

Privately and Publicly Financed Home-Based Nursing Study Update

In the Fall of 2003, Peter Coyte (Co-Principal Investigator), Denise Guerriere (Co-Principal Investigator), Patricia McKeever (Co-Investigator, Faculty of Nursing) and Ada Wong (Research Assistant) launched the Determinants and Outcomes of Privately and Publicly Financed Home-Based Nursing study. The study was funded by the Canadian Health Services Research Foundation (CHSRF).

Study Summary

The environment in which home-based nursing and personal support services are delivered is increasingly constrained by personnel shortages and escalating health care costs. As a result, care recipients may receive a mixture of publicly and privately financed home-based services, as well as care provided by unpaid family members. Despite the need for the delivery of efficient and effective nursing care and personal support assistance, a limited understanding of the use, cost, and outcomes of these home-based services exists. This study will assess determinants of publicly and privately financed home-based nursing and personal support service utilization. Determinants such as socio-economic status, amount of informal caregiving, and geographic location of residence will be considered. The relationship between publicly and privately financed home-based nursing and personal support services and the quality of care, as well as the costs to the system and to care recipients will also be evaluated. A greater appreciation of home-based nursing and personal support services is necessary for practitioners, health service managers, and policy decision makers to ensure that care recipients and their families receive efficient, effective, equitable, and quality care. Decision-making around the allocation of resources in a financially constrained environment may be facilitated through an accurate depiction of the home care context where nursing and personal support services are provided and received.

Community Care Access Centres (CCACs)

The University of Toronto research team works in partnership with six CCACs across Ontario, including Algoma, Brant, Etobicoke and York, Grey-Bruce, Haliburton, Northumberland and Victoria and Ottawa. The Executive Director or the Director / Manager of Client Services from each participating CCAC functions as a Decision-Maker Partner for the study. These Partners have been involved in the development of the objectives and formulation of the research questions. They will continue to be involved by participating in all stages of the research process. For the study, the CCACs assist in the identification and recruitment of potential study participants, based on predetermined eligibility criteria (see Participant Recruitment). Once potential clients are identified, a CCAC representative contacts the client to ask: 1) if he/she is interested in learning more about the study; and 2) for his/her permission to release their contact information to the Research Assistant.

Participant Recruitment

The data collection phase of the study is currently underway. Adult, English speaking clients of home-based nursing and personal support services (excluding those receiving palliative service) are eligible. Two types of participants are being recruited:

1. Short-term clients: Clients are eligible if they started receiving in-home nursing services within the past seven days and if they are expected to receive in-home services for no more than 60 days from their start date.
2. Continuing care clients: Clients are eligible if they have been receiving in-home nursing and/or personal support services for the past 60 days (with no more than one week break in services) and if they are expected to receive in-home services for the next 30 days or more.

The target sample size is 512 participants, which will include 256 short-term clients and 256 continuing care clients. As of the end of July 2004, 296 participants were recruited, representing 64% of total referrals. Of these, 54% were continuing care clients and 46% were short-term clients.

Data Collection

Ten determinants of home-based nursing and personal support service utilization are being considered for the study: age, sex, marital status, cohabitation status, level of education, income, informal caregiving, CCAC region, geographical location of residence (urban/rural), and ability to perform activities of daily living. These 10 determinants were chosen because they have been identified in previous studies as predictive of home-based health service use, and because they may provide insight into the determination of whether efficient, effective, equitable, and quality care is being delivered. To collect information on the 10 determinants, data are obtained from the following questionnaires: 1) Ambulatory and Home Care Record (© Coyte & Guerriere, 1998) to assess economic outcomes; 2) a demographic data form; 3) Older Americans' Resources and Services Activities of Daily Living Scale (© Fillenbaum, 1988) to measure functional ability; 4) Chronic Conditions module of the Canadian Community Health Survey (Statistics Canada, 2002) to measure co-morbidity; and 5) Quality of Care Survey (The NRC+PickerGroup Canada, 2000) to obtain families' opinions about the care they received. Each study participant is interviewed over the telephone once a week for four weeks. Each interview lasts about 15 minutes. It is anticipated that data collection will be completed by the end of 2004.

For a printable version of this update, please click here (Adobe PDF). For more information on the study, please contact Research Assistant Ada Wong at: adaym.wong@utoronto.ca .

Research and Teaching Profiles

Faculty associated with the Department of Health Policy, Management and Evaluation (HPME) are involved in a broad range of research activities with a variety of organizations. Success of the HPME Knowledge Transfer initiative is dependent on presenting our stakeholders with a unified, clear image of the depth and breadth of Departmental expertise. To promote greater internal awareness of the knowledge developed through HMPE, faculty research profiles are a regular feature of the newsletter.

This issue of the HPME newsletter features a research profile for Paula Goering.

+ + PROFILE OF THE MONTH + +

Paula Goering, PhD

Paula Goering is a Professor of Psychiatry in the UofT Faculty of Medicine and is cross-appointed to the Faculty of Nursing, Institute of Medical Science and the Department of Health Policy, Management and Evaluation. Dr. Goering has extensive experience in the area of mental health service delivery as a clinician, consultant, educator and researcher. As the Director of the Health Systems Research and Consulting Unit at the Centre for Addictions and Mental Health (Clarke Site), Dr. Goering has developed linkages between policy, research and practice, earning a CIHR/CHSRF Chair in Health Services Research. The Chair, entitled Generating and Disseminating Best Practices in Mental Health and Addictions, has created opportunities for interdisciplinary training, mentorship and research and collaboration between researchers and policymakers on the integration of mental health services in Canada.

Education and Work Background

Dr. Goering completed her Bachelor of Science in Nursing at the University of Kansas, her Master of Science in Psychiatric Nursing at Yale University, and her PhD at the University of Toronto (Institute for Medical Sciences). After moving to Canada in 1971, she worked as a Project Director and Mental Health Consultant with the Queen Street Mental Health Centre and Clarke Institute of Psychiatry. Dr. Goering has been a faculty member at UofT in the Faculty of Medicine and Faculty of Nursing since graduating with her doctorate in 1985. In her role as Director of the Health Systems Research and Consulting Unit (HSRCU) at CAMH, Paula Goering has overseen a wide range of applied research activities that include synthesis of existing scientific information for policy and planning use, designing and conducting investigations for specific providers and planners, and education of stakeholders.

Dr. Goering has worked with policy decision makers at both the federal and provincial levels. In Ontario, assistance has been provided through a series of working papers that have helped to define the service models, systems and targets which underlie mental health reform. This work has been cited extensively in the official provincial mental health policy documents. She has recently directed comprehensive assessment projects in many of the Ontario provincial psychiatric hospitals. A Best Practices in Mental Health Reform project, conducted in collaboration with government and professional organizations resulted in three documents that have been widely circulated nationally and internationally.

The following reports are samples of Dr. Goering's work that have been used in policy and planning:

• Koegl, C., Durbin, J. & Goering, P. Mental Health Services in Ontario: How well is the province meeting the needs of persons with serious mental illness? Analysis of data collected during the Provincial Psychiatric Hospital and the Comprehensive Assessment Projects (CAP). 2004. (Full text in PDF - 1 MB)
• Rush, B., Shaw-Moxam, R., Nadeau, L., McMain, S., Ogborne, A., Goering, P., Roberts, G., Rosidi, S. & Mueser, K. Best Practices: Concurrent Mental Health and Substance Use Disorders. Report submitted to Health Canada. 2002. (Full Text in PDF - 390KB)

Research Activities

Dr. Goering's research activities have focused on the improvement of mental health service delivery, particularly for those with severe and persistent mental illness. She has published over 90 articles in a wide range of refereed journals and frequently presents scientific papers at international meetings. She has studied the delivery of aftercare services to discharged psychiatric patients, depression in married women, conducted a longitudinal evaluation of case management programs, a follow-up study of supportive housing residents and a needs assessment of homeless women. The Ontario Mental Health Supplement and A Pathways into Homelessness study provided epidemiological descriptions of community and shelter populations. Collaborations with the Institute for Clinical Evaluative Sciences are focused on the mental health component of service delivery.

Currently, Dr. Goering is the co-Principal Investigator on a $1.8 million Canadian Institute for Health Research (CIHR) grant, Building capacity in mental heath and addictions services and policy research and co-Investigator on a $.25 million CIHR grant, Examining the effectiveness and cost-effectiveness of a mobile treatment team approach to delivering care for first episode psychosis.

A sample of recent publications include:

• Jacobson, N., Butterill, D., and Goering, P. Organizational Factors that Influence University-Based Researchers’ Engagement in Knowledge Transfer Activities. Science Communication, 25(3): 246-259, March 2004.
• Goering, P., Butterill, D., Jacobson, N. & Sturtevant, D. Linkage and exchange at the organizational level: A model of collaboration between research and policy. Journal of Health Services Research and Policy, 8 (Suppl. 2):14-19, 2003.
• Dewa, C.S., Rochefort, D., Rogers, J. & Goering, P. Left Behind by reform: The case for improving the primary care and mental health system services for people with moderate mental illness. Applied Health Economics and Health Policy, 2(1):43-54, 2003.
• Goering, P., Tolomiczenko, G., Sheldon, T., Boydell, K. & Wasylenki, D. Characteristics of persons who are homeless for the first time. Psychiatric Services, 53(11):1472-1474, 2002.

Teaching and Supervisory Responsibilities

Paula Goering plays a major role in the supervision of students. She is currently supervising 5 doctoral students and 1 post-doctoral fellow. As Director of the Health Systems Research and Consulting Unit (HSRCU), Dr. Goering has overseen the development of a wide variety of training and mentorship opportunities in addiction and mental health services research and policy analysis and knowledge transfer and exchange. The Summer Studentship Program provides undergraduate and graduate students an opportunity to gain research experience and skills in an inter-disciplinary environment. The Postdoctoral Research Fellowship in Health Services Research and Program Evaluation provides highly motivated PhD and MD graduates the opportunity for mentored training and collaboration with a dynamic multidisciplinary team of researchers engaged in studies of addictions and mental health services delivery, access, and quality. The Resident Research Rotation provides psychiatry residents with an opportunity to complete a research project under the supervision of PhD-level research scientists. (For more information about any of these programs, please contact Dr. Carolyn Dewa, the Student Programs Coordinator, at Carolyn_Dewa@camh.net.)

The HSRCU's Research Transfer Training Program (RTTP) provides training in research transfer for CAMH and University of Toronto, Department of Psychiatry scientists and researchers. This training assists researchers to improve their capacity to communicate research results to two key audiences: policy developers and mental health/addictions organizations. (For more information please contact Dale Butterill at : Dale_Butterill@camh.net .) The RTTP was offered on three occasions between July 1, 2001 and June 30, 2002. Over thirty-five scientists/ researchers from the U of T Department of Psychiatry, and CAMH participated. It will be offered again next spring at both CAMH and at HSC. In addition, under Dr. Goering's leadership, the HSRCU developed a new course based out of the Department of HPME called Knowledge Transfer and Exchange (HAD 5727) which she co-teaches with Dale Butterill and Nora Jacobson.

Future Research and Training

• Health Systems Research and Consulting Unit: www.camh.net/hsrcu/knowledge.html
• CHSRF/CIHR Chair Awards: www.chsrf.ca/cadre/bio_goering_e.php

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