developing an agenda for public health systems research in bc marjorie macdonald, rn, phd professor,...
TRANSCRIPT
Developing an Agenda for Public Health Systems Research in BC
Marjorie MacDonald, RN, PhDProfessor, School of Nursing
University of VictoriaCIHR/PHAC Applied Public Health Chair
On Behalf of the CPHFRI Team
Funders
• Michael Smith Foundation for Health Research• Canadian Institutes of Health Research • CIHR-PHAC Applied Public Health Research
Chair to Marjorie MacDonald• BC Ministry of Health, PHABC, BC Health
Authorities• Public Health Ontario, Ontario MOHLTC, six
health units in ON
Co-Authors• Trevor Hancock, Professor and Senior Scholar, School of
Public Health and Social Policy, University of Victoria
• Bernie Pauly, Associate Professor, School of Nursing, University of Victoria & Scientist, Centre For Addictions Research of B.C. (CARBC)
• Warren O’Briain, Executive Director, Communicable Disease Prevention, Harm Reduction and Mental Health Promotion, BC Ministry of Health
• Heather Wilson Strosher, CPHFRI Coordinator, University of Victoria
Purpose of Presentation
• To define PHSSR and argue for its importance in the overall context of public and population health research
• To describe the first efforts in Canada (BC) to establish the field of PHSSR, present the initial research agenda, and report on progress
• To present an emerging agenda for PHSSR in BC• To attract new researchers to the field from across
the country
What is PHSSR?
• In the US, initially called Public Health Systems Research (PHSR) - “the investigation of the dynamic properties and interactions of the public health system, its infrastructure, and their effect on population health status” (Van Wave, 2010)
• Then, to capitalize on the research and methodological developments of health services research, the word “services” was inserted into the title (PHSSR)
6
What is PHSSR?Public health systems and services research (PHSSR) is defined as “a field of study that examines the organisation, funding and delivery of public health services within communities, and the impact of these services on public health”
Mays, Halverson & Scutchfield, 2003, p, 180
Population Health
Research
Public Health
ResearchPHSSR
7
• Funding for health services research is directed primarily at the health care system in general, and not at public health services per se. This creates a “public health system knowledge disparity.”
Honoré, P.A. & Amy, B.W. (2005). “Public Health Finance: Advancing a Field of Study Through
Public Health Systems Research” Journal of Public Health Management & Practice, 11(6), 571 -573
Core Public Health Functions Research Initiative (CPHFRI)
A collaborative program of Public Health Systems and Services Research in BC involving long-standing and strong partnerships between knowledge users and researchers
History of CPHFRICreated to conduct research on Core Functions Framework implementation in BC• 2006 - Conceptualization of the idea and
development of team • 2006-07 - Team Planning Grant – MSFHR & MoH o Think Tank – Research Agenda April 2007o Developed Principles of KU-Researcher Collaboration
• 2008-2011 - Team Start-Up Grant – MSFHR & MoHo Grant Proposal preparation in line with research agenda
10
Overarching Goals of CPHFRI
• Public health systems renewal in BC and Canada• Advancing public health systems/services research in BC
and Canada• Methodological development for studying complex
public and population health interventions & systems• Training public/population health researchers• Contributing to evidence-informed practice and public
health practice improvement• Improving the health of the population and promoting
health equity
11
KTE
Equity
Partnersh
ipsM
ethods
Core Public Health
Functions Framew
ork* Context and Process of Implementation
Outcomes of PH Renewal
Core Competencies for PH
Linking PH and PHC
Equity Lens Integration
Evidence to Practice
Initial Five Year Agenda - 2007
*21 Core PH Programs.Equity & Population Lenses.PH Strategies (prevention, promotion, protection, surveillance).PH System Capacity (infrastructure, HHR)
• Since its inception in 2006, CPHFRI has attracted close to $6 million in peer-reviewed funding
• All of the initial priority areas identified at the 2007 Think Tank have been funded
• 13 PHSSR proposals submitted, 12 were funded
12
Funding Received
Funded Projects Over 7 Years
• 2 completed MSFHR infrastructure grants (2006-11)
• 7 completed CIHR projects (1 operating grant, 2 knowledge syntheses, 2 MPDs, 1 PHIR grant, 1 KT supplement - 2008-12)
• 1 CIHR/PHAC Applied Public Health Chair (2008-14)
• 2 CIHR programmatic grants in progress– Renewal of Public Health Systems (REPHS) Emerging Team
Grant (2009-2014, with extension to 2015)– Equity Lens in Public Health (ELPH) Pathways to Health
Equity Grant (2011-2017)
13
Critical Success Factors
• An opening policy window (post-SARS)• An identified need by knowledge users for
evidence and research to guide new policy initiatives
• Methodological innovation and risk taking• CIHR – IPPH Strategic Plan • Integrated KT at its best - a truly collaborative
relationship between KUs and researchers
Critical Success Factors
• A collaborative, systematically designed research agenda with KU buy-in
• Capitalizing only on funding opportunities consistent with research priorities
• A rigorous training platform integrating students at all levels
• Collaborative dissemination by both KUs and researchers in multiple forms
• A critically reflexive process
Challenges
• Of success (research burden)• Different research/organizational cultures
(needs, rewards, expectations)• Methodology (slow, labour intensive,
privacy/ethics issues)• Resources (infrastructure, costs)• Sharing results (needed sooner rather than
later; initially not nimble enough)
Renewing the Agenda
CONTEXT:• All initial research priorities funded• Well established relationships/collaborations• Shifting public health context and policies• The name CPHFRI no longer resonating for the
team or relevant in current policy context• Thus, a Think Tank was held to renew the
research agenda for another 5 years
Goals of Think Tank
• Celebrate the successful launch of a PHSSR agenda in British Columbia that began in 2007;
• Develop consensus on a PHSSR agenda for BC for the next 5 years;
• Start a process to revision and rename CPHFRI; and
• Expand the network of PHSSR researchers and supporters.
Think Tank Participants
45 Participants representing:– 4 BC Universities – 7 BC Health Authorities (including FNHA)– BC Ministry of Health– CIHR: IPPH & IHSPR– NCCDH– MSFHR– US National Coordinating Center for PHSSR– London-Middlesex HU
New Issues
• Expanding the definition of the “public health system” to include non-PH providers and non-traditional partners and places– E.g., NGOs, business, faith organisations,
municipalities• Multisectoral approaches, partnerships,
coalitions• ROI/ PH economics
New Issues (cont.)
• Community interests/engagement• Research on decision-making• Intervention research• Link to outcomes–Positive health measures – viz FNHA
• PH data and info systems• More nimble research (Quick Strike studies)
KTE
Equity
Population &
System *
Intersectoral/Multisectoral Collaboration
PH Decision-Making
PH System Ethics
Pop Health Interventions
PH Economics
Data and Info Systems for PH
PH Workforce
PH System Organisation
Public Health
Complexity
Partn
erships
Outcomes
Met
hods **
** Natural Experiments, Complexity Methods, PH Economics, Quick Strikes
* The collective infrastructure and actions of individuals and public, private and voluntary organizations that contribute to local, regional, provincial, national and global health and wellness through promotion, prevention and protection.
* The collective infrastructure and actions of individuals and public, private and voluntary organizations that contribute to local, regional, provincial, national and global health and wellness through promotion, prevention and protection.
PH Economics
PH Organization
PH Decision
Making
PH Workforce
Pop Health
Interventions
Intersectoral
/Multisectoral
CollaborationData
& In
fo
Syst
ems f
or P
H
PH Et
hics
The collective infrastructure and actions of individuals and public, private and voluntary organizations that contribute to local,
regional, provincial, national and global
health and wellness through promotion, prevention and protection.
PH Economics
PH Workforce
Data & Info Systems for PH
PH Decision Making
Intersectoral/Multisectoral Collaboration
Pop Health Interventions
PH Organization
Future Plans
• Re-visioning and renaming CPHFRI• Completing KT plans• Expanding our researcher – knowledge
user base• Securing infrastructure funding• Pushing forward on a Pan-Canadian PHSSR
agenda• International Collaborations
25
26
For more information about CPHFRI:
http://web.uvic.ca/~cphfri/
Marjorie MacDonald: [email protected] or
CPHFRI Coordinator: Heather Wilson [email protected]