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President’s Message ………………………………………………….……………………………………………………….... 3 Providence Research Proles ……………………………………...……………………………………….……….….. 4 Dr. Graeme Koelwyn …………………………………………………………………………………………...…...... 5 Dr. Adeera Levin …………………………………………………………….………………………………………….… 8 Dr. Anita Ho …………………………………………………………………….………………………………………......11 Dr. Tillie Hackett ……………………………………………………………………………………………………….. 14 Dr. Lillian Hung ………………………………………………………………….……………….…………………..... 16 Dr. Kate Salters ………………………………………………………………………………………………………..... 18 Dr. Je Reading …………………………………………………………………….………………………………….... 21 Dr. Carl Brown ………………………………………………………………………………………………………..…. 24 Dr. Amy Salmon ………………………………………………………………………………………………...….…… 27 Research Highlights ….……………………………………………………………………………………………………..… 30 Research on new seniors’ village to happen in real time ………….…………………………... 31 Road to Recovery research to evaluate program’s impact, ways to best improve care ……………………………………………………………………………………………………....35 Order of British Columbia recognizes nurses’ exemplary careers providing life-saving care in the DTES ...…………………………………………………………………………….……... 49 New report gives insight into the harmful impact of air pollution on COPD ….…… 44 Does a low-carb, high-fat diet increase your risk of heart disease?…………………..…. 47 Stories from Skunkworks …………………………………………………………………………………………..….…. 50 Brainstorming ways to bring wound care to those in need ………………….…………..…… 51 Skunkworks: Ideating how to help seniors age well …………………………………...……..…. 54 PHIR+E: Advancing Innovation with Providence Research………….…………………………..58 PHIR+E and Centre for Digital Media bring a solution from Skunkworks: Hacking Aging to life ….……………………………………………………………………………………….…..... 60 Meet our Team ………………………………………………………………………………………………………………..…. 64 Connect with Us ……………………………………………………………………………………………………………...…. 65 Contents
3 Summer 2024 President’s Message Dear Readers, It is with great pleasure that I welcome you to this, our rst issue of the Providence Research Review Magazine. In these pages, you will nd inspiring stories of our many globally recognized researchers, updates on the CSRC and Skunkworks, and insights that reect the dedication and innovation within our health research community at Providence. Our commitment to advancing health research has never been more critical. In an era marked by unprecedented global health challenges, rapid scientic advancements are crucial. From combating emerging diseases and pandemics to improving chronic illness management, our research endeavours are driving progress and generating hope. As we look to the future, I hope these stories inspire. The path ahead will bring new challenges, but with inspiration, together with collaboration, ingenuity and support, I am condent that we will continue to make signicant strides in improving health resilience. I extend my deepest thanks to our story contributors, reviewers, sta and readers for their support. We look forward to bring you new stories each year. Best wishes, - Darryl Knight PRESIDENT: Dr. Darryl Knight MANAGING EDITOR: Susan Ogilvie EDITOR: Grace Jenkins Research Review Magazine is published by Providence Research, 1190 Hornby Street, Vancouver, BC V6Z 2K5, 604-806-9090, fax 604-806-8568, providenceresearch.ca Dr. Darryl Knight
Summer 2024
5 Summer 2024 Providence Research Proles: Dr. Graeme Koelwyn Dr. Graeme Koelwyn is a Principal Investigator with the Centre for Heart Lung Innovation (HLI) and an Assistant Professor in the Faculty of Health Sciences at Simon Fraser University (SFU). He is also the Dr. James Hogg Chair and Tier 2 Canada Research Chair in Public Health ‘Omics in Exercise and Disease at St. Paul’s Hospital. He runs the Koelwyn Lab, a translational research program that studies the association between exercise and disease outcomes, particularly regarding how exercise inuences the immune system and inammation. Dr. Koelwyn’s research focuses on using exercise physiology to improve outcomes in patients with certain diseases with precisely timed and dosed exercise interventions. Kinesiology, speed skating led to research career Dr. Koelwyn’s undergraduate students at SFU often ask him why he decided to pursue a career in research. “I don’t think I ever saw myself as a researcher, particularly when I was at their stage, in undergrad,” says Dr. Koelwyn. His undergraduate degree was in Kinesiology at the University of Calgary. At that time, he was also a speed skater, training in the National High-Performance Program at the Olympic Oval, located within the Kinesiology department, and he was interested in learning how athletic performance could be improved through the science of exercise. Research was not on his radar until a professor involved him in some research projects near the end of his degree, which he found very engaging. “It was the pursuit of interesting questions, and being in a position where you can actively explore your own curiosity and nd answers to questions that could help others,” says Dr. Koelwyn. These initial projects opened more opportunities, and it was exciting to combine his interest in exercise physiology with medicine. “Now, my research program is really focused on how we can use exercise as a treatment to improve the underlying biology of dierent diseases, which translates into benets for patients.” Dr. Graeme Koelwyn Principal Investigator, HLI
6 Summer 2024 Studying how exercise can improve patient outcomes Before Dr. Koelwyn began his role at the HLI in 2021, he completed his PhD in Pathobiology and Translational Medicine at the NYU Grossman School of Medicine, followed by a Postdoctoral Fellowship at Memorial Sloan Kettering Cancer Center in New York City. Much of his research in New York focused on understanding the impact of exercise on the initiation and progression of cancer at a cellular level, as well as on tumor biology. Not only do more physically active people have a lower risk of certain types of cancer, but those who exercise after receiving a cancer diagnosis have a lower risk of their disease progressing. Dr. Koelwyn found that exercise regulates the immune system, helping it react to cancer cells in a way that slows disease progression. At the HLI, he applies what he learned about cancer to diseases that similarly dysregulate the immune system, like sepsis, heart disease and lung disease. Inammation is a connecting thread between these diseases. Dr. Koelwyn is investigating if specic exercise interventions can help normalize immune function and inammation to improve disease outcomes in these patients. For example, exercise is generally benecial for Dr. Koelwyn and students conduct research at the Koelwyn Lab. L-R Georey Nonis, Anmol Malhi, Dr. Graeme Koelwyn
7 Summer 2024 patients living with heart disease, but the biological mechanisms behind these benets are not fully known. “We know that [exercise] improves quality of life and reduces cardiac events, but we don’t fully know how it’s doing that,” says Dr. Koelwyn. He is working with collaborators in the Healthy Heart Program and Cardiac Rehabilitation at St. Paul’s Hospital to better understand how exercise inuences the immune system and inammation, which is a known driver of heart disease progression. Another current project involves patients who develop sepsis, a dysregulated immune response to an infection, while in the Intensive Care Unit at St. Paul’s Hospital. Survivors of sepsis face continuing challenges, including a high risk for subsequent cardiovascular events, such as a heart attack, in the years following their time in the hospital, as well as recurrent infections. Dr. Koelwyn is investigating how appropriately ‘dosed’ exercise might be able to reorient the immune system, decrease inammation in sepsis survivors, and reduce the risk for these subsequent events. Collaborating to solve complex problems Throughout his journey, Dr. Koelwyn has been fortunate to have had people who supported him. “I’m only in the position I am in because I've had incredible support from my family throughout this entire journey, as well as mentors and colleagues who have provided me with opportunities to learn and train in supportive and exciting research environments,” says Dr. Koelwyn. Now that he has his own lab, he makes an eort to create mentorship opportunities, to enable people to explore their passions, and to help student trainees take the next steps in their careers. One of Dr. Koelwyn’s favorite aspects of the research process is bringing together a team of interdisciplinary clinicians, researchers, and students to collaborate to explore research questions that could not be answered alone. He enjoys working with individuals from diverse backgrounds and areas of expertise to solve complex problems that have the potential to help many people. Dr. Koelwyn is an inherently curious person, and being able to align his curiosity with the pursuit of research questions that have the chance to improve the lives of patients, who don’t currently have many options to treat their conditions, motivates him in his research. “I think like many of us, I’ve always wanted to have a career where I love what I do, and that what I do may one day also help others.” says Dr. Koelwyn. “I think like many of us, I’ve always wanted to have a career where I love what I do, and that what I do may one day also help others.” - Dr. Graeme Koelwyn.
8 Summer 2024 Providence Research Proles: Dr. Adeera Levin Dr. Adeera Levin is the Executive Director of the BC Renal Agency, a Consultant Nephrologist at St. Paul’s Hospital, the Senior Medical Lead, Integration Clinical and Academic Networks at Providence Health Care, and a Scientist with the Centre for Advancing Health Outcomes. She is also a Professor of Medicine and the Head of the Division of Nephrology at the University of British Columbia. Dr. Levin’s research is focused on the clinical practice of nephrology, examining variability within chronic kidney disease (CKD) progression, cardiovascular disease (CVD) in CKD patients, and health outcomes. She has leveraged her epidemiological training, clinical knowledge, and health outcomes research to enhance the care of patients across the continuum of kidney care. As a recognized leader in her eld, she has collected many prestigious awards throughout her career, including the Order of Canada in 2015 for her leadership in kidney disease treatment. More recently, she received the International Society of Nephrology’s 2024 Jean Hamburger Award, which recognizes outstanding research in nephrology with a clinical emphasis. “Dr. Levin is, of course, highly deserving of this prestigious award,” says Fiona Dalton, President & CEO of Providence Health Care. “As a long-time nephrologist and respected research leader at St. Paul’s Hospital and Providence Health Care, Dr. Levin’s passion for research, drive for new knowledge, and commitment to improving the lives of patients are unparalleled. Her contributions to the eld of kidney research and care can never be celebrated enough. She is genuinely seless, always focused on the needs of others, and leads in a manner that inspires others to always be exceptional in everything they do.” Curiosity led to career in research Dr. Levin received her medical degree from McMaster University medical school, which had a Dr. Adeera Levin Scientist, Advancing Health
9 Summer 2024 prominent emphasis on epidemiology research. The mentorship she received there, together with the university’s research focus, sparked her curiosity and set her on the path towards her career in research. “In the context of medical school, I didn’t think you could do anything other than ask questions,” says Dr. Levin. She was drawn to her focus in nephrology because the kidneys are responsible for pivotal functions that impact the entire body, from ltering the blood and maintaining uid levels to creating and regulating important hormones that help control blood pressure and red blood cell production. “Understanding kidney disease is both intellectually satisfying, but also allows you to take care of people, acutely, as well as chronically, with both rare diseases and chronic diseases, so you get to establish long-term relationships with a huge diversity of people and their families,” says Dr. Levin. “Plus, it’s a little bit like doing a crossword puzzle – everything kind of adds up.” While the systems the kidneys manage can be complex, by underTstanding how they are all connected, Dr. Levin can use data from lab tests and blood work to ll in the blanks and understand what is happening – a little like a crossword puzzle. “To me, that’s always been the fun of nephrology,” says Dr. Levin. Leadership in the eld of nephrology research In her role as Executive Director of the BC Renal Agency, which coordinates health services for patients with kidney disease in B.C., Dr. Levin oversees the organization’s governance and strategic direction. She ensures that BC Renal has the necessary planning and nancial support to provide high quality, evidence-informed care. Additionally, she is the co-principal investigator for Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), a patient-oriented network grant aiming to create innovative kidney care solutions. Through supporting the Canadian Nephrology Trials network, which advances clinical trials research in kidney health, and creating KidneyLink, an online platform to connect researchers to patients and family members, Can-SOLVE CKD has helped to “As a long-time nephrologist and respected research leader at St. Paul’s Hospital and Providence Health Care, Dr. Levin’s passion for research, drive for new knowledge, and commitment to improving the lives of patients are unparalleled. Her contributions to the eld of kidney research and care can never be celebrated enough.” - Fiona Dalton, President & CEO, Providence Health Care.
10 Summer 2024 transform nephrology research across Canada by bringing research to the forefront of clinical care paradigms. Dr. Levin has been involved in many signicant research projects, with over six hundred peer-reviewed publications, and has conducted clinical trials to understand the impact of particular interventions on kidney patient outcomes, contributing signicantly to the advancement of nephrology research and patient care. She has acted as a site investigator for national and international steering committees to look at new medications to delay the progression of kidney and heart disease. Some recent publications include a study of the role of the medicine canagliozin in kidney protection of patients with type 2 diabetes, and a report published in The Lancet Global Health on global disparities in kidney disease burden and care. Seeing research as a team sport Dr. Levin draws inspiration for her research from the patients and families she works with. “Knowing that you can help take better care of people and answer important questions is part of what gets me up in the morning,” says Dr. Levin. She is additionally motivated by being able to mentor the next generation and collaborate with other researchers. “To me, research is very much a team sport, and so the other thing that’s really wonderful about it is working in teams of talented individuals, with everyone working on the same goal of trying to answer an important question,” says Dr. Levin. Dr. Levin is a leader in nephrology research. “Knowing that you can help take better care of people and answer important questions is part of what gets me up in the morning.” - Dr. Adeera Levin.
11 Summer 2024 Providence Research Proles: Dr. Anita Ho Dr. Anita Ho is a scientist with the Centre for Advancing Health Outcomes, a Clinical Associate Professor in the University of British Columbia’s Centre for Applied Ethics, and an Associate Professor with the University of California, San Francisco’s Bioethics Program. Dr. Ho’s work as a bioethicist combines clinical research, organizational ethics, and technology ethics, particularly surrounding the use of articial intelligence (AI), and frames broader conceptual analyses in the context of social and environmental determinants of health. She also supports clinical teams in making complex decisions, particularly in situations where there may not be a clear-cut answer. Training in a diverse variety of elds led to interest in bioethics Dr. Ho received her rst degree in marketing, which she still draws upon in some of her current work. During this degree, she took an elective course in bioethics, which raised interesting philosophical questions that she hadn’t previously considered. These questions surrounded what it means to provide clinically and ethically appropriate care in culturally diverse societies, what respect and the promotion of well-being require when patients' refusal of treatment may cause physical harm, and how to provide equitable care in an unequal world. Dr. Ho’s interests in these intersecting issues prompted her to pursue a master’s degree in public health and a PhD in philosophy, with a focus on biomedical ethics. During her PhD program, driven by her lifelong passion for music, she also completed a master’s degree in piano performance. Research on ethical implications of AI technology Dr. Ho’s current work involves exploring the ethical considerations of developing and adopting AI technologies in health care. One of her empirical studies looked at the concerns of people living with Parkinson’s disease, their family members, and clinicians regarding the use of AI technology to continuously monitor for Parkinson’s disease symptoms. Dr. Anita Ho Scientist, Advancing Health
12 Summer 2024 Dr. Ho’s work also examines how AI technology has changed our relationship to privacy, and how that may impact how people interact with each other and with healthcare providers. Will concepts of privacy be changed by environments where someone is not being observed by any other human, but is being watched by AI? How might this impact one’s ability to say no to constantly being monitored? “My concern is that a lot of information that is being collected is not actually useful for promoting people’s wellbeing or their health. We don’t always know what happens to all the information being collected, who has control over it, how it is being shared or sold, and for what purpose,” says Dr. Ho. Dr. Ho recently published a book on the ethics of AI health monitoring, Live Like Nobody is Watching: Relational Autonomy in the Age of Articial Intelligence, which looks at three dierent use-cases for AI monitoring in healthcare; for elderly or disabled people living at home, direct-to-consumer applications, and for monitoring medication adherence, particularly in the contexts of mental health and pain conditions. Dr. Ho analyzes whether the use of AI in these cases would truly promote people’s autonomy. The decisions people make regarding AI health monitoring are not made in a vacuum, but are framed by social structures, institutional decisions, and professional relationships, which impact how patients see themselves and whether they genuinely have the freedom to decline to be monitored. “As we have more and more technologies being used to help people live safely at home, I think that decision-makers need to really consider how broader structural questions may actually frame “My concern is that a lot of information that is being collected is not actually useful for promoting people’s wellbeing or their health. We don’t always know what happens to all the information being collected, who has control over it, how it is being shared or sold, and for what purpose.” - Dr. Anita Ho Dr. Ho’s book, Live Like Nobody is Watching
13 Summer 2024 people’s freedom to decide whether to use these technologies, or their ability to really use these technologies in ways that are most suitable for them,” says Dr. Ho. Using data to conceptualize ethical problems One of Dr. Ho’s current projects is looking at the use of AI chatbots that aim to promote better psychological wellbeing, connectedness, and to ease loneliness for people who live with various mental health conditions. Another project explores clinicians’ perspectives on using mortality prediction models in end-of-life care. “I want to see whether these technologies actually promote people’s wellbeing or more appropriate care plans, or whether they may also, in many ways, change the dynamics in therapeutic relationships,” says Dr. Ho. As a philosopher by training, Dr. Ho thinks a lot about conceptual understandings of ethical issues. As a researcher, she wants to empirically know what patients and members of the public think about the ethical decisions made by medical professionals. “What motivates me is really having a good understanding of how people relate to the healthcare system, how they really think about the impact of their social environment and the healthcare system on their ability to make decisions based on their own values and priorities,” says Dr. Ho. “Even though I’m trained as a philosopher, that empirical data can help us to understand some of the ways people conceptualize dierent problems, so that we can provide better solutions.” Dr. Ho with her book “I want to see whether these technologies actually promote people’s wellbeing or more appropriate care plans, or whether they may also, in many ways, change the dynamics in therapeutic relationships.” - Dr. Anita Ho.
14 Summer 2024 Providence Research Proles: Dr. Tillie Hackett This month, we are proling Dr. Tillie Hackett, a Principal Investigator with the Centre for Heart Lung Innovation, a Professor in the Department of Anesthesiology, Pharmacology and Therapeutics at the University of British Columbia, and a Tier 1 Canada Research Chair in Asthma and COPD Pathobiology and Therapeutics. She recently received the Mentoring Research Award from AllerGen for her outstanding work as an educator and researcher dedicated to improving the lives of patients living with asthma and COPD. Dr. Hackett’s research focuses on airway remodeling in people with asthma and chronic obstructive pulmonary disease (COPD). Both of these conditions can cause damage and scarring of the lungs, which reduces lung function. “What we want to try and do is see how we can reverse that scarring, so we can make sure that people can breathe easily every day,” says Dr. Hackett. Research ranges the spectrum from diagnosis to treatment Dr. Hackett is an international leader in using ultra-resolution imaging to investigate asthma and COPD. In 2008, she and her team used this technology to show that by the time a person is diagnosed with the earliest form of COPD, they have already lost over forty-one per cent of the smallest airways in the lung. Now, Dr. Hackett is investigating how to use ultra-resolution imaging to identify people who will develop asthma and COPD earlier, and develop treatments that could change the course of this scarring. Dr. Hackett has also done a signicant amount of work in single-cell imaging and ‘omics. By looking down at the single-cell level, she and her team are trying to understand what dierences are present in the lungs and cells of a person with asthma or COPD. Another aspect of Dr. Hackett’s research involves testing cell models to discover eective treatments. Cell samples taken from asthma and COPD patients are grown into models that mimic Dr. Tillie Hackett Principal Investigator, HLI
15 Summer 2024 the lung environment. Dr. Hackett and her team are then able to test dierent drugs on these cells to understand what treatments could be used to improve how the lung functions. “We are a translational lab. We are trying to diagnose the patient earlier, we are trying to understand what happens to cells in disease using our ultra-resolution imaging, and then we are trying to use our human-cell models to try and better treat those diseases. By doing all of this, we hope to nd better treatments to improve the lives of patients,” says Dr. Hackett. Helping the next generation get their start Dr. Hackett wanted to be a scientist ever since she hear the word ‘biochemistry’ at school when she was seven, and thought that it sounded cool. When she was able to do her rst research project as a student at the University of Southampton in the UK, she was inspired by the process of experimentation and research. That is a common thread she has seen in the trainees that have come through her lab. “That rst summer student or co-op project, where you really actually get to do research, is what excites everyone to join research later on,” says Dr. Hackett. Dr. Hackett appreciates the opportunity to train the students and trainees in her lab. “They are the people who, after me, are going to continue this research. Playing a big part in how they shape their lives and their careers is very inspiring,” says Dr. Hackett. While many of us may take the ability to breathe for granted, there are millions of people worldwide who are impacted by asthma and COPD and who struggle to breathe every day. Dr. Hackett’s research aims to change that. “I think what drives me is that I want to make sure that people can have treatments to help them breathe more easily every day. It’s quite a thing, when you take a breath, and it’s not relieving,” says Dr. Hackett. “I want to make sure that people can have treatments to help them breathe more easily every day. It’s quite a thing, when you take a breath, and it’s not relieving.” - Dr. Tillie Hackett. Dr. Hackett is an international leader in using ultra-resolution imaging to investigate asthma and COPD.
16 Summer 2024 Providence Research Proles: Dr. Lillian Hung Dr. Lillian Hung is a scientist with the Centre for Advancing Health Outcomes, the Canada Research Chair in Senior Care, and the founder and head of the UBC IDEA (Innovation in Dementia & Aging) Lab. Dr. Hung’s research focuses on innovating and improving dementia care. This includes nding solutions to address clinical problems in care facilities and acute hospitals, and examining the impact of technology and environment on patient care. Initial research project funded through PHC Research Challenge Dr. Hung began her research career while working in the acute psychiatry unit at Mount Saint Joseph Hospital. She and her team noticed that the environment in their unit was lacking for their older patients, many of who were experiencing severe depression or dementia, and they wanted to take action to better support their patients. This inspired Dr. Hung’s rst research project, which gathered data through conducting patient observations and interviews on what could be done to improve their living environment. The project was funded through the PHC Practice-based Research Challenge, an annual competition lead by Aggie Black, Director of Health Services and Clinical Research and Knowledge Translation at PHC. The challenge provides point-of-care PHC sta who may be new to research the opportunity to learn how to design and implement a research project. Dr. Hung and her team published their ndings and used them to successfully advocate for funding to renovate the unit. “That’s how it got started, that was my rst project,” says Dr. Hung. Discovering technology to full unmet needs Driven by her experience as a clinician, Dr. Hung is always looking for better ways to support her patients, and for new technologies that can help address patients’ unmet needs. Dr. Lillian Hung Scientist, Advancing Health
17 Summer 2024 “I consider myself more of a clinician-scientist, even though I have an academic job. Most of my research was driven by my clinical work and my long years of experience working with clinical teams, my patients and my residents in long-term care,” says Dr. Hung. She is the founder of the UBC IDEA Lab, which connects health system planners, researchers, patients and students to create innovative solutions in dementia and aging through patient-oriented research. One example of the technology she studies are the Lovots, Mango and Kiwi, which are AI-enabled companion robots that emulate lifelike behaviours. Dr. Hung is conducting a study to determine if they can improve the quality of life of people with dementia by addressing loneliness and boredom. At the IDEA Lab, Dr. Hung works with a large team that includes students from many dierent disciplines, as well as patient and family partners. The Centre for Advancing Health Outcomes supports Dr. Hung’s research, particularly in the areas of knowledge translation and research promotion. The relationships she has built with her colleagues, students and patient partners are very rewarding. Getting to see the impact of the technology she is studying greatly motivates Dr. Hung in her research – for instance, seeing how a robot can ‘brighten up’ a person who is struggling emotionally and help them have conversations about emotional needs is extremely gratifying for her. “These people that I work with, people living with dementia, they’re really extraordinary, and I have the opportunity to work with them from project to project,” says Dr. Hung. “These people that I work with, people living with dementia, they’re really extraordinary, and I have the opportunity to work with them from project to project.” - Dr. Lillian Hung. The Lovots on display at Skunkworks: Hacking Aging
18 Summer 2024 Providence Research Proles: Dr. Kate Salters Dr. Kate Salters is a research scientist at the BC Centre for Excellence in HIV/AIDS at St. Paul’s Hospital (BC-CfE) and an adjunct professor in the Faculty of Health Sciences at Simon Fraser University (SFU). Her research focuses on how to improve health outcomes and health care engagement for people living with HIV and hepatitis C. She is among the scientists at the BC-CfE involved in the recently announced collaboration between the BC-CfE, the BC Centre for Disease Control, and the provincial government to advance B.C.’s goal of eliminating hepatitis C as a public health threat by 2030. Chronic hepatitis C, a liver infection caused by the HCV virus, can lead to serious health problems including liver damage, cirrhosis, liver cancer and even death. Improving health outcomes and services for people with hepatitis C, HIV After working as an international health consultant and sexual health educator, Dr. Salters originally joined the BC-CfE as a research coordinator in 2011. She was mentored there by BC-CfE senior research scientist Dr. Robert Hogg. In 2013, she pursued a PhD in health services with a focus on epidemiology at SFU, supervised by Dr. Hogg and Dr. Angela Kaida. Following that, she completed a postdoctoral fellowship with Dr. Ann Burchell at St. Michael’s Hospital, where she led research that investigated HPV among people living with HIV. In late 2018, she was recruited back into the BC-CfE, this time as a research scientist. In this role, she was tasked with leading the BC-CfE’s Viral Hepatitis Research Program, and has grown the program to focus on improving health outcomes and health services for people living with and vulnerable to HIV and Hepatitis C. The epidemiological research she conducts often focuses on the intersections between hepatitis C, HIV, and mental health and substance use disorders. She is motivated by the ability to share her team’s results and ndings with both the academic and non-academic communities. She leads the BC-CfE’s long-running knowledge translation and community engagement series Snack Chat, where health researchers bring food and present their research to those involved. She is passionate about bringing research back to communities who Dr. Kate Salters Scientist, BC-CfE
19 Summer 2024 participate in research but often do not get see the results. Dr. Salters appreciates her position as someone who has the privilege of doing this research, especially as a woman in a STEM eld. She acknowledges how fortunate she is to have wonderful mentors who have helped her navigate and learn how to do action-oriented, engaged research. Exploring connections between research, harm reduction and advocacy Much of Dr. Salters’ most recent research has involved looking at the role of harm reduction services in transforming health care engagement. She is passionate about the signicant roles that advocacy and community engagement play in infectious disease health services research. L-R: Dr. Julio Montaner, BCCfE; Sophia Bartlet, BCCDC; Dr. Kate Salters, BCCfE; Adrian Dix, BC Minister of Health. “Working in the eld of HIV, you learn very quickly the value of community engagement and advocacy. It kind of switched my perspective from research as something that is purely academic, to research as something that is about activism and action.” - Dr. Kate Salters.
20 Summer 2024 “Working in the eld of HIV, you learn very quickly the value of community engagement and advocacy. It kind of switched my perspective from research as something that is purely academic, to research as something that is about activism and action,” says Dr. Salters. One of her recent projects, which received funding from the Canadian Institutes of Health Research, looked at how to improve connections to health care for people who use drugs, a demographic that hepatitis C disproportionally impacts. While people who use drugs are frequently tested for hepatitis C, they face signicant barriers to actually accessing life-saving treatment. “How do we move beyond just testing priority populations for infectious conditions, and eventually move to understanding how we can better engage them safely and eectively in health care that works for them? That, I think, is a real interest and passion point for me,” says Dr. Salters. This is where harm reduction can play a role in health care engagement. People who use drugs, who may be hesitant to go to a primary care clinic or a family doctor’s oce to receive care, may be more inclined to receive care at a supervised consumption or harm reduction site. The goal of Dr. Salters’ research is to aect real change, such as increasing the scope of clinical care in harm reduction settings, advocating for new and novel harm reduction interventions that better respond to the needs of the community, and better connecting people to health care and life-saving treatments. “Instead of thinking of health care as one thing, sexual health as another, and harm reduction as yet another, I think we need to build a new framework for how and what healthcare looks like that is designed with the realities and the priorities of the people we serve in mind,” says Dr. Salters. “Instead of thinking of health care as one thing, sexual health as another, and harm reduction as yet another, I think we need to build a new framework for how and what healthcare looks like that is designed with the realities and the priorities of the people we serve in mind,” - Dr. Kate Salters.
21 Summer 2024 Providence Research Proles: Dr. Je Reading Dr. Je Reading, PhD, the First Nations Health Authority Chair in Heart Health and Wellness at St. Paul’s Hospital, has been appointed as a member to the Order of Canada. The Order of Canada recognizes outstanding achievement, dedication to the community, and service to the nation. Dr. Reading has been appointed as Member, The Order of Canada (M.C.) for his groundbreaking contributions to Indigenous health research and for his leadership in bringing Indigenous perspectives to scientic and health institutions. Improving the health and wellbeing of Indigenous people. Dr. Reading is an Indigenous researcher from a Mohawk community of the Tyendinaga First Nation in Ontario. He is a leading international expert in Indigenous health, with more than two decades of experience in enhancing knowledge on Indigenous health issues. “I don’t think it’s any secret that there’s quite a gap in health and life expectancy for First Nations, Inuit and Métis people in Canada,” says Dr. Reading. Throughout his career, he has worked with academics, doctors, and other health care providers to narrow this gap. As the First Nations Health Authority Chair in Heart Health and Wellness at St. Paul’s Hospital, Dr. Reading leads research that focuses on improving wellbeing and access to healthcare for Indigenous people and investigates the root causes of those disparities in health outcomes. Because the Chair was established through a partnership between Providence Health Care’s St. Paul’s Hospital, the First Nations Health Authority, the Heart and Stroke Foundation, and Simon Fraser University, this role presented a unique opportunity to collaborate with people from across those domains. “The reason I was attracted to the role was because it combines the creation of new knowledge – research – with the health care system and the provision of care, like at St. Paul’s Hospital and Providence Health Care, with advocacy and policy work, which is the health Dr. Je Reading FNHA Chair in Heart Health and Wellness, St. Paul’s Hospital
22 Summer 2024 authority and the Heart and Stroke Foundation,” says Dr. Reading. “It’s a unique way of doing research, and translating that research into policy.” In one research project, they are conducting a longitudinal maternal-child cohort study with the aim of optimizing the health and well-being of children from an Indigenous community. The study will collect data on biological markers, social and economic factors such as education, and traditional issues such as access to traditional food, language and cultural activity as these children grow and develop. “The idea is to be able to look at the developmental origins of health and disease,” says Dr. Reading. Ethical research guidelines to protect Indigenous communities Dr. Reading has been instrumental in the creation of ethical guidelines for the conduct of research surrounding Indigenous communities. “There’s a long history of Indigenous people being exploited by researchers, who didn’t obtain informed consent or adhere to ethical protocols that were agreed to,” says Dr. Reading. That history has caused ‘research’ to have very negative connotations for Indigenous people. Dr. Reading helped to create ethical guidelines to build trust and provide protection for research participants, so their health needs can be addressed. Beyond conducting research to improve the health and well-being of Indigenous people, Dr. Reading’s work also builds capacity within Indigenous “We have to think about creating a safe environment, so that everyone, when they need healthcare, has the right access to that healthcare, free of discrimination.” - Dr. Je Reading.
23 Summer 2024 communities themselves to meet their own research needs in the future, which will better position them to nd solutions to pressing problems. Addressing barriers to care A signicant part of Dr. Reading’s research focuses on access to health care. Indigenous people can face stigma and barriers to care while navigating their healthcare journeys, particularly when it comes to chronic conditions like diabetes, heart disease, cancer and mental health and addiction. “We have to think about creating a safe environment, so that everyone, when they need healthcare, has the right access to that healthcare, free of discrimination,” says Dr. Reading. He believes that the construction of the new St. Paul’s Hospital presents an opportunity. “It’s a time to rethink the way we’re doing things, and looking at how Indigenous people will have equal access to the care that they need, when they need it.” Looking to the future, Dr. Reading wanted to highlight people, such as St. Paul’s cardiology fellow Dr. Miles Marchand, who are immersed in First Nations’ culture and tradition, while holding signicant positions at academic and medical institutions, and are able to act as bridges between these institutions and their communities. “Surprised and delighted” to be inducted into the Order of Canada When Dr. Reading received a message from the Governor General of Canada’s oce, he initially though he was being asked for a letter of support for someone else’s nomination to the Order of Canada. “I was very surprised and delighted to learn that they were actually inducting me into the Order, especially since the Governor General is an Indigenous leader - Mary Simon, who is Inuit - so that makes it extra special,” says Dr. Reading. “It’s a big honour, and I am very humbled to be included in something like this.” Order of Canada badge “It’s a big honour, and I am very humbled to be included in something like this.” - Dr. Je Reading.
24 Summer 2024 Providence Research Proles: Dr. Carl Brown Over the next few months, in an eort to shine a light on our many notable researchers, Providence Research will be proling the careers of those who work within our inspiring research community. This month we are proling Dr. Carl Brown, a leading colorectal surgeon at St. Paul’s Hospital and the recipient of the 2023 Research and Mission Award. This award recognizes a scientist in our organization who demonstrates the mission and values of Providence Health Care while conducting outstanding research. Dr. Brown has conducted groundbreaking research into colorectal cancer treatment and has been integral to the development of multiple research groups at Providence Health Care. Beyond Vancouver, Dr. Brown has provided many surgeries to patients in Guatemala as part of the volunteer health care team Health for Humanity. The Research and Mission Award winner was announced at an event on June 16th at the Sheraton Wall Centre. Previous recipients include Drs. Anita Palepu, James Hogg, Bruce McManus and Julio Montaner. “These are luminaries of research and thought leaders in their respective elds, and Providence is an incubator for those types of thinkers. To be considered among that group of clinicians is an incredible honour,” says Dr. Brown. He emphasizes that, while this award recognizes his work as an individual, it is a reection of the success of his team as a whole. Building the colorectal research team When Dr. Brown began working at St. Paul’s Hospital in 2006, he was one of just two colorectal surgeons. Over time, he helped establish a team that prioritized clinical research, funded through partnerships with both grant-funded research projects and technology companies interested in advancing surgical care. He has grown the team, which now consists of ve surgeons, in addition to research coordinators, graduate students, clinical fellows, and surgery trainees. Dr. Carl Brown Colorectal Surgeon, St. Paul’s Hospital
25 Summer 2024 Much of the research done by Dr. Brown and his team involves the use of technology to improve outcomes for patients with colorectal cancer, with a large focus on minimally invasive surgery and surgical techniques that reduce incisions and pain while improving the ability to reconstruct the bowel. Dr. Brown is a global leader in minimally invasive procedures such as Transanal Endoscopic Microsurgery and Transanal Total Mesorectal Excision (TaTME). Dr. Brown’s team has relationships with general surgeons across the province who send them patients to receive this care. This has allowed them to gain a high volume of experience with the novel techniques the team has developed. “We’ve been able to oer [TaTME] to British Columbians, and that has really helped with their surgical recovery and their ability to have reconstruction after surgery,” says Dr. Brown. He also introduced the Enhanced Recovery after Surgery program at St. Paul’s Hospital, an award-winning initiative that has improved the post-operative patient experience and reduced hospital stays. Part of the colorectal cancer team at St. Paul's Hospital performing surgery. “The work we do is to try to help people in some of their darkest days, with a cancer that they may not feel comfortable talking about with their friends and family.” - Dr. Carl Brown.
26 Summer 2024 Supporting the Providence Breast Centre research team Dr. Brown also played an integral role in supporting the research team at the Providence Breast Centre at Mount Saint Joseph Hospital. Early on in Dr. Brown’s time at St. Paul’s Hospital, he met Dr. Elaine McKevitt, a breast and general surgeon also working at St. Paul’s at the time. “She and I were likeminded when it came to trying to improve patient care,” says Dr. Brown. Dr. McKevitt later moved to Mount Saint Joseph Hospital and helped develop the Providence Breast Centre with Dr. Rebecca Warburton and her colleagues. Their team wanted to conduct research and had plenty of good ideas, but minimal funding – a similar situation to the colorectal research team. Dr. Brown was able to advise them on how to get their research up and running. “Through that collaboration, they’ve really become a leading light in breast cancer research, nationally and internationally. They’re doing incredible work over there,” says Dr. Brown. Representing the values of PHC When Dr. Brown rst came to St. Paul’s Hospital, he felt that there was a sense that general surgery was on life support. There were few surgeons, and it was dicult to recruit more. He is proud to have been a part of the team that has resuscitated that institution and has taken Providence Health Care to being a leader in many dierent elds of surgery. “It’s been an exciting time to be at Providence throughout this experience,” says Dr. Brown. Providence Health Care has a long history of caring for people with stigmatized conditions, such as mental illness, substance use, and HIV. There is a dierent, but very real, stigma surrounding colorectal cancer - people are often embarrassed and reluctant to talk about it. “The work we do is to try to help people in some of their darkest days, with a cancer that they may not feel comfortable talking about with their friends and family,” says Dr. Brown. He believes that this perfectly represents the kind of work Providence Health Care exemplies, and why he was selected this year’s recipient of the 2023 Research and Mission Award. The Providence Breast Centre Team. L-R: Dr. Urve Kuusk, Kirsty Carpenter, Dr. Elaine McKevitt, Dr. Rebecca Warburton, Priscilla So, Nancy Khuu
27 Summer 2024 Providence Research Proles: Dr. Amy Salmon Over the next few months Providence Research, in an eort to shine the light on our many notable researchers, will be proling the careers of those who work within our inspiring research community. This month we are proling Dr. Amy Salmon, Centre Associate Director with the Centre for Advancing Health Outcomes (Advancing Health), a clinical faculty member with UBCs School of Population and Public Health, and recently appointed Director of Clinical Faculty Aairs, with the UBC Faculty of Medicine. In this new role, she will be providing leadership and support for the clinical faculty within the UBC Faculty of Medicine. UBC has close to 11,000 clinical faculty members – faculty members who are practicing health professionals, whom Dr. Salmon will help connect and engage with. “The reason that I’m a clinical faculty member is because I’ve always sought out and preferred to do research and evaluation work that’s embedded inside the health system,” she says. Her research at Advancing Health focuses in the areas of health system and services. She works with programs within Providence Health Care to improve how they are delivering care to patients. Throughout her career, she has been drawn in her work to programs focused on integrated care for people who have more complex health needs. Providence Health Care and Advancing Health are leaders in bringing developmental evaluation into the health systems and services landscape. “It’s something unique that we oer, that isn’t duplicated within other health care organizations in the province, and I think we’re seeing the benets that this approach to evaluation brings,” says Dr. Salmon. Transforming systems with research and evaluation Before she came to Advancing Health, her research focused on health system and services approaches involving the delivery of integrated care services to people aected by mental health and substance use issues. She worked Dr. Amy Salmon Associate Director, Advancing Health
28 Summer 2024 with Sheway, an outreach program that provides support for pregnant people aected by those issues in Vancouver’s Downtown East Side. Advancing Health recruited her in 2016 to lead the developmental evaluation of Foundry, a province-wide network of health services focused on youth mental health and substance use. While Dr. Salmon had previously been working with a dierent population, the integrated health and social care model they were working to develop, was very familiar. Dr. Salmon’s applied health systems and services research involves working in partnership with programs within Providence Health Care, as well as other health authorities and organizations, which are aiming to transform their services. Because programs working in this system-transformation mindset are innovating from the ground up, not improving or replicating a pre-existing initiative, they often have clear long-term goals, but do not have evidence available to help make important decisions about how best to achieve them. That is where Dr. Salmon comes in to support these programs. Often, this is through embedding developmental evaluation and research in the early stages of these system transformation initiatives. This allows near-real time data to be collected that leaders in the health system can use to make decisions about how to build these programs. Dr. Salmon began working with Advancing Health’s seniors and long-term care programs in 2018, focusing on eorts to transform the culture of care provided in long-term care homes. Care for seniors Dr. Salmon is leading a research evaluation of Providence Living at The Views
29 Summer 2024 is an organizational and clinical focus at Providence Health Care, but it has been challenging in the past to attract and support the scientists needed to focus on health systems and services for this patient group. She brought together the Seniors Care Research Group, a team who share a strong passion for seniors care and research to support this patient population. They are working to develop a multidisciplinary senior’s care research program that will position them to support other forms of system transformation in the seniors care space. Collaboration to advance health outcomes One of Dr. Salmon’s favorite parts of the work she does at Advancing Health is getting to collaborate with a skilled, passionate and diverse group of people who have a common goal of advancing health outcomes for many dierent people inside our health system. “I’m very inspired by the work that my colleagues do here, and I feel very grateful to have an opportunity to help contribute to the collective work that we do here,” she says. While there are challenges facing the health care system, she gets to witness and support the energy for meaningful change that she sees inside it. “From my vantage point as an embedded researcher, I just really feel very grateful to have the opportunity to support people who see those challenges, who take them seriously, and who are rolling up their sleeves to create something much better, that our society needs and that I think we can all be proud of.” At Providence Research, we are most fortunate to have Dr. Salmon exploring new avenues of care and options for PHC’s patent population and surrounding community. “From my vantage point as an embedded researcher, I just really feel very grateful to have the opportunity to support people who see those challenges, who take them seriously, and who are rolling up their sleeves to create something much better, that our society needs and that I think we can all be proud of.” - Dr. Amy Salmon.
30 Summer 2024
31 Summer 2024 A research evaluation of Canada’s rst public, non-prot long-term care village based on the concept of a dementia village will demonstrate the impact of an innovative new model of care on residents’ quality of life, sta care practice, and family experience outcomes. It will also oer insights for real-time improvements while it is being implemented. The number of seniors and people living with dementia is on the rise in Canada. The population of people aged 85 and older is one of the fastest-growing, and a 2022 report from the Alzheimer’s Society of Canada projects that by 2030 nearly one-million Canadians will be living with dementia. Given these trends, there is a need for innovation in long-term care. Providence Living at the Views, set to open in Comox, British Columbia this summer, will be implementing a made-in-BC model of long-term care called Home for Us, which was jointly created by Providence Living and Providence Health Care and incorporates best practices from around the world. The village will accommodate seniors with Research on new seniors village to happen in real time Providence Living at The Views
32 Summer 2024 and without dementia and younger adults requiring long-term care. Funded by the St. Paul’s Foundation, the evaluation will look at the two main components of the village project: the new Home for Us model of care and its physical environment. “This will be the rst evaluation, certainly in Canada, of an implementation of this dementia-village type model in a publicly funded context,” says Dr. Amy Salmon, a scientist with the Centre for Advancing Health Outcomes (Advancing Health) and a Clinical Associate Professor with UBC’s School of Population and Public Health, who is leading the evaluation. Village model prioritizes autonomy, social connections The key principles of the Home for Us model of care that Providence Living at the Views will be implementing are: emotional connections matter most; home is not a place, but a feeling; and residents direct each moment. Unlike traditional long-term care settings, where care practices and routines are often dictated by institutional processes, Providence Living at the Views will oer residents the freedom to shape their own daily routines and activities, fostering a sense of independence and purpose, which studies show plays a vital role in active, healthy aging. Fostering meaningful relationships is central to Home for Us. Residents will be supported to maintain strong family and community connections, and empowered to enjoy autonomous, meaningful lives. The model ensures that care providers have time to get to know who residents are as people while delivering excellent care. The concept for Providence Living at the Views was inspired by the Hogeweyk care home in the Netherlands, the world’s rst ‘dementia village’. Drawing on learnings from the Hogeweyk, Providence Living at the Views aims to provide an environment that feels like home, not like an institution. The 156-bed village will be structured into households of up to twelve residents, and will include amenities like a bistro, a childcare centre, an art studio, and community spaces. “The village model provides a setting where residents can go out of their own households to neighbourhood destinations that we all go to, like a grocery store, a café, restaurant, or other places of interest,” says Dr. Habib Chaudhury, an Advancing Health scientist and Professor of Gerontology at Simon Fraser University who is leading the portion of the evaluation focusing on the impact of the village’s physical environment. His team will evaluate resident and sta outcomes in relation to the physical design of the village and households. “That’s the fundamental idea of the physical setting Dr. Amy Salmon
33 Summer 2024 of the village model, to create neighborhoods with familiar destinations and accessible outdoor spaces, rather than just housing.” While constructing the physical village infrastructure requires signicant time and investment, Home for Us can be implemented throughout all existing and newly built Providence long-term care homes in collaboration with local health authorities. Gathering data to maximize residents’ quality of life The evaluation aims to assess the impact of both the Home for Us care model and the physical environment on patient’s quality of life and identify areas that could be improved going forward. Qualitative data on the project is collected through interviews with residents, sta and family members, and ethnographic methods are used to map out residents’ daily lives. Researchers additionally use clinical and administrative data to compare outcomes with other long-term care homes. This collection, which began in 2021 and will conclude in 2026, will enable researchers to compare data from before and after the village opens. Additionally, the evaluation team will use human resource data from Providence Health Care to track indicators of sta well-being. “This new long-term care model, both the physical setting and the Home for Us care model, will hopefully impact sta’s job satisfaction as well, and they will become more eective in providing support and care to the residents every day,” says Dr. Chaudhury. The evaluation is a large-scale project involving the collaboration of Advancing Health scientists from four universities. Dr. Salmon coordinates and supports the involvement of team members who bring specialized skills to the project, like Dr. Chaudhury. Dr. Habib Chaudhury “We’re hoping that the evidence that’s generated through this evaluation will help people to make decisions about scaling up. Not just whether it should happen, but also how, and where the most important investments in this change can be made with the goal of maximizing resident’s quality of life and wellbeing.” - Dr. Amy Salmon.
34 Summer 2024 “This has been a wonderful opportunity at Advancing Health for people to nd new ways to work together, and how our expertise across our own dierent institutions, departments, and disciplines allows this kind of inquiry to thrive,” says Dr. Salmon. The evaluation aims to ensure that the Home for Us and the village environment supports the goal of Providence Living at the Views to deliver the highest quality standard of care. The knowledge gained from this evaluation will help to guide further implementation of this model of care. “We’re hoping that the evidence that’s generated through this evaluation will help people to make decisions about scaling up. Not just whether it should happen, but also how, and where the most important investments in this change can be made with the goal of maximizing resident’s quality of life and wellbeing,” says Dr. Salmon. Providence is working toward a future where communities around the world will be empowered to reform the existing institutionalized model of seniors’ care and adopt one that puts residents rst. Providence Living at the Views will only be one example of the implementation of this innovative model. The new St. Vincent’s Heather long-term care home, in Vancouver, will implement the Home for Us social-relational model of care when it opens to residents. The project is currently in the rezoning process with the City of Vancouver. Construction is expected to start in 2025 and be complete in 2028. Living area at Providence Living at the Views
35 Summer 2024 The Road to Recovery Initiative (R2R) is an innovative model of care that aims to transform the way substance use treatment is coordinated and delivered in BC. Co-developed by the Providence Health Care (PHC) Division of Addiction and the BC Centre on Substance (BCCSU), it will focus on providing a full continuum of substance use care, to help patients access the right support when they need it. In parallel to the rollout of the R2R’s clinical services, an extensive program of research will be conducted to evaluate how the program is working and to understand patients’ experiences with it. The knowledge gained through this research will be used in real time to improve the program and inform how the R2R can be successfully implemented in other regions of the province. Addressing gaps in the addiction treatment system Accessing safe and appropriate recovery services Road to Recovery research to evaluate pro-gram’s impact, ways to best improve care Road to Recovery provides a full connuum of substance use care.
36 Summer 2024 can be a major challenge for people with a substance use disorder. Through the R2R, people seeking addiction treatment will be able to access a comprehensive range of treatments, including acute stabilization and withdrawal management, transitional housing, and long-term recovery services. “Under one umbrella, individuals can access harm reduction services, inpatient detox, transitional or short-term stay beds, inpatient recovery, and longitudinal follow-up through our outpatient clinics,” says Dr. Seonaid Nolan, clinician scientist with the BCCSU and Division Head of PHC’s Interdepartmental Division of Addiction. Dr. Nolan co-created the Road to Recovery program along with the BCCSU’s Executive Director, Cheyenne Johnson. “It was really born out of our front-line experience, recognizing that there are numerous gaps and fractures in our addiction treatment system. We wanted to put pen to paper to sketch out what a functioning addiction treatment system would look like,” says Dr. Nolan. The R2R will expand treatment capacity with the creation of ninety-ve new addiction treatment beds. The rst fourteen-bed stabilization and withdrawal management unit opened at St. Paul’s Hospital in September 2023, and twenty transitional care beds located in the community opened in October. Over the next several years, this continuum of services will be scaled up to meet the demand for care. The program will collaborate with partners including PHC, the Ministry of Mental Health and Addiction, Vancouver Coastal Health (VCH), and PHC and VCH’s Regional Addiction Program to centralize and coordinate access to detox and recovery programs, as well as referral pathways between treatment providers. This will help ensure that the system is streamlined, easy to navigate – for administrators and patients, and provides the appropriate type and level of support that patients need at the exact moment that they are looking to access it. Parallel research to improve the program Dr. Nolan is leading the comprehensive health services evaluation and observational study that will follow individuals receiving care through this new service model. This research aims to evaluate the implementation of R2R services and the outcomes of people who access them, capture patient experience and satisfaction with these Dr. Seonaid Nolan
37 Summer 2024 services, and identify opportunities for improvement. “Any new model of care, intervention, or medication – pretty much any change in a system of care or how you treat patients – requires a thoughtful research evaluation to occur in parallel, so that we can continue to inform our evidence base and ensure that the new approaches to care are based in science,” says Dr. Brittany Dennis. Dr. Dennis, a clinician scientist with the BCCSU and physician with PHC’s Interdisciplinary Division of Addiction Medicine, will be co-leading the prospective cohort study of the R2R, which is a major component of the research evaluation. She received the 2023 Michael Smith Health Research BC Scholar Award and the Carraresi Foundation Early Career Clinician Investigator Award to support her role. The prospective cohort study will recruit patients who are accessing care through R2R services in order to explore the impact of this care on health, substance use trajectories, and social outcomes. It will draw on data from multiple sources, including qualitative and quantitative data from patient interviews and questionnaires and system-level data administrative data. Given the chronic nature of substance use, researchers will follow patients who access R2R services over time, capturing detailed information about socio-demographic characteristics, physical and mental health conditions, substance use behaviors as well as harms caused by substance use. As time passes, researchers will reassess this information to establish patterns of interaction and connection with R2R services and determine how these services impact health and substance use outcomes. They will also employ novel methods of data linkage through several administrative databases, allowing researchers to see how participants are managing years out from accessing R2R services. The program of research also includes a qualitative evaluation, where patients will be asked to Dr. Brittany Dennis “In the end, this is a program of research developed by patients, for patients, to answer big questions about how we can best improve and evaluate our standard of substance use care.” - Dr. Brittany Dennis.
38 Summer 2024 participate in interviews focused on their experience with the R2R and how access to this model of addiction treatment may have impacted their health or substance use trajectories, and overall quality of life. These interviews will also gather suggestions on how to improve the service to better address the needs of patients seeking care. This evaluation has made intentional eorts to identify and measure outcomes that reect patient values and preferences, and the team is committed to better understanding patient-important outcomes. Capturing both outcomes that are traditionally used to establish program eectiveness, like treatment retention and substance use behaviors, as well as those considered important to patients, such as employment, access to housing, and reestablishing family connections, is prioritized in both the quantitative and qualitative streams of the evaluation. The nal aspect of this program of research includes a comprehensive health services evaluation which will use system-level data to help researchers understand service needs and factors impacting capacity while also characterizing the populations accessing R2R services, with specic attention to how patients migrate through the substance use system of care. In total, this program of research will operate over a ten-year span. Participants will be recruited over the course of ve years, and their outcomes will be tracked for another ve years beyond that. Research and data will be emerging throughout this period as the program continues to evolve. Research will help understand program’s impact on patient outcomes Evidence on how to best treat patients with a substance use disorder is still growing, and in light of BC’s substance use crisis, it is an especially important area of study. “The overarching aim here is to demonstrate that, through data collection and in an evidence-based fashion, if we can better coordinate service delivery for people who use substances, they will do better over time,” says Dr. Nolan. This research program aims to understand the impact of oering comprehensive, coordinated addiction care on patients’ health, social, and substance use outcomes. The information and data collected through this research will be used to ensure this new model of care is operating as eciently and seamlessly as possible, and will allow the researchers to make improvements for patients in real time. “In the end, this is a program of research developed by patients, for patients, to answer big questions about how we can best improve and evaluate our standard of substance use care,” says Dr. Dennis. “The overarching aim here is to demonstrate that, through data collection and in an evidence-based fashion, if we can better coordinate service delivery for people who use substances, they will do better over time.” - Dr. Seonaid Nolan.
39 Summer 2024 Home-care nurses Evanna Brennan and Susan Giles have been appointed to the Order of British Columbia, the highest civilian recognition in the province, in honour of their remarkable careers providing life-saving care to people living with HIV/AIDS and signicant health issues in Vancouver’s Downtown East Side (DTES). The Order recognizes those who have served their communities with distinction and have excelled in their elds, benetting people in British Columbia and beyond. Previous PHC-aliated appointees include Dr. Julio Montaner and Dr. Bruce McManus. “We’re completely blown away by the whole event. We’re just completely blown away,” says Evanna. Since the 1980s, Susan and Evanna have worked to provide and develop an innovative model of care, working closely with the BC Centre for Excellence in HIV/AIDS and St. Paul’s Hospital. They saw the beginning of the HIV epidemic and witnessed the drug and overdose crisis develop into what it is today. Throughout it all, they have remained Order of British Columbia recognizes nurses’ exemplary careers providing life-saving care in the DTES Evanna Brennan and Susan Giles. Photo: Courtesy Tallulah Photography.
40 Summer 2024 stalwart pillars care and compassion for Vancouver’s most vulnerable population. The DTES, a neighborhood with disproportionally high levels of drug use, homelessness, poverty, crime, and mental illness, became their area of primary patient care and most urgent need. Complex health care problems began to ramp up in earnest in the eighties with an inux of hard drugs and the start of the HIV epidemic. “Lucky or unlucky, we just happened to be there at the beginning,” says Evanna. Adapting home-care nursing Susan and Evanna recognized that typical home-care nursing methods did not t this patient population, so they adapted the process to work in these circumstances. Their patients would not go to clinics, so they would track them down and bring care to them. Sometimes that meant asking someone’s drug dealer where to nd them, or dressing a wound in a bar. Before there were eective HIV treatments, they mostly provided palliative care, but palliative care looks dierent for someone who uses drugs. They learned how to provide care in that situation together with an outreach doctor, Susan Burgess, whom they continued to work with over the years. They also received support from the BC Centre for Excellence in HIV/AIDS and the Canadian Association of Nurses in AIDS Care. An innovative model for nursing – Action Based Care Susan and Evanna used their experience to develop an innovative model for nursing called Action Based Care. It is a holistic, relationship-based approach to medicine that incorporates harm-reduction principles. It is designed create access to care and meet patients where they are. A core part of their care is respecting the patient’s autonomy and space. “It’s that respect. The same way that you would want respect if a health person came into your home,” says Evanna. “That’s hard to do, when you know you can help them, or make life much easier for them. But it’s not what we’re asked to do by them.” Action Based Care also involves putting aside any judgements or prejudices to focus on building care around what works best for the patient. Evanna Brennan and Susan Giles in the DTES. Photo: Courtesy Tallulah Photography.
41 Summer 2024 “It’s not easy to like people who use self-destructive things,” says Susan. “But you have to kind of accept that, or you’re always going to be in conict over what you’re doing.” They go above and beyond typical home-care nursing, including buying food and other supplies out of their own pockets. Filling those needs helps build the trust needed to get the nurses through the door, and the relationships that are a core facet of Action Based Care. Susan and Evanna have fond memories of one of their patients, a woman with HIV who was twenty-two when she passed. “She was easy to love. She really was easy to love,” says Evanna. In the end, she could not really eat, but she loved slurpies. Susan and Evanna would bring them to her. “I’m so glad we did that.” Persevering through the years The two retired from their positions with Vancouver Coastal Health in 2012, but continue to provide care as independent contractors. The DTES is an unsafe area, but people there are protective of Evanna and Susan. They stick out as nurses, and their patients - and their patient’s drug dealers - know who they are. Their close partnership has been key to them being able to continue this work for so long. They originally went out as a pair for safety, but quickly realized the benets of being able to combine their expertise to provided augmented patient care and support each other through chaotic situations. Their compassion has also driven them to continue. “If you’ve seen someone die of AIDS, you will do anything to get that person to be able to take the meds, to stop looking like a skeleton and being so sick,” says Susan. “And we had seen that, so it really spurred us on.” The problems in the DTES have only grown more severe over the years. In one building they work in, nine people overdosed within two months. Susan Brennan and Giles have provided care in the DTES since the 1980s. Photo: Courtesy Tallulah Photography. “It’s that respect. The same way that you would want respect if a health person came into your home.” - Evanna Brennan.
42 Summer 2024 and Evanna used to go to every funeral. Today, they can’t keep up. “I didn’t think it could get worse, but it is worse. The drugs are worse, the homelessness is worse, the street scene is more violent,” says Susan. “And the overdoses are shocking,” says Evanna. Contributing to nursing education Susan and Evanna have shared the knowledge they have gained over the years, contributing signicantly to nursing education in BC, Canada and beyond. They have taught nursing students from Canada, the US, Europe and Asia, and have presented at national and international conferences. “I hate the phrase ‘make a dierence,’ but it actually did make a dierence for some of those people who were terried of the Downtown East Side,” says Evanna. “They had never been there before, they saw the people as far too dierent, and they didn’t know how to approach them. Then they saw how we were doing it.” “A lot of them reected afterward in their journals that it made them less afraid to talk to people. They’re people, just like everyone else,” says Susan. They want to continue to mentor other nurses and help inuence the next generation. They hope that the documentary that covered them and their work, Angels on Call (2020), could be used as an educational tool and help spread the philosophy of Action Based Care. The health care problems in the DTES do not have simple solutions, but in Susan and Evanna’s knowledgeable opinions, increasing housing, shelter beds, and access to mental health care, along with better long-term addiction treatment and recovery, could help alleviate some of them. They would also love to be able to break down the barrier of people being afraid to approach drug users and others who live in the DTES. They believe that only through knowing this population as they do, can we overcome the painful turbulence that exists in this community. Brennan and Giles contributed signicantly to nursing educaon. Pho-to: Courtesy Tallulah Photography. “If you’ve seen someone die of AIDS, you will do anything to get that person to be able to take the meds, to stop looking like a skeleton and being so sick. And we had seen that, so it really spurred us on.” - Susan Giles.
43 Summer 2024 “Blown away” by Order of British Columbia appointment When Susan and Evanna received a phone call informing them that they were being appointed to the Order of British Columbia, they were completely surprised – they had no idea that they were nominated. “I started to cry,” says Evanna. “I just couldn’t believe it. I was just emotionally, and in every other way, shocked. Thrilled to bits, as well.” Susan was in disbelief, even suspecting that it might be a spam call. “I think I interrupted her and said, is this for real? This doesn’t sound real. And she went, ‘Oh it’s real, it’s real.’” They are honoured to be in the company of those who have previously been appointed to the Order, and are grateful to everyone who was involved in their nomination. “Two Skid Row nurses. Really, how did we get into the books? We somehow got into the books. I don’t get it!” says Evanna. Susan and Evanna have saved uncounted lives over the years by providing lifesaving medication and wound treatment to those who otherwise would have fallen through the cracks of the medical system. They have reduced harm and built relationships with some of Vancouver’s most vulnerable people, and are very worthy additions to the Order of British Columbia. “Two Skid Row nurses. Really, how did we get into the books? We somehow got into the books. I don’t get it!” - Evanna Brennan.
44 Summer 2024 Wildres, dust storms, heatwaves and other extreme events linked to climate change will have profound consequences on the world’s air quality and are major threats to patients with Chronic Obstructive Pulmonary Disease (COPD), says new research. A new report led by Providence Research scientist Don Sin summarizes the impact of air pollution on COPD and provides a direction to improve the care and outcomes for patients with COPD worldwide. Exposure to air pollution is a major contributor to the development and exacerbation of COPD. Notably, while cigarette smoking is the leading risk factor for COPD, air pollution is the leading known risk factor for lifetime non-smokers. Dr. Sin, Director of UBC’s Centre for Heart Lung Innovation at St. Paul’s Hospital, led the review, commissioned by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Committee. It works with health care professionals and public-health ocials from around the world to raise awareness and improve the prevention and treatment of COPD. New report gives insight into the harmful impact of air pollution on COPD Air polluon can worsen COPD, according to a new report. Photo: Courtesy Jimmy Liao, Pexels.
45 Summer 2024 Air pollution worsens COPD Air pollution is a mixture of gasses and particles in the air, both of which contribute to and worsen COPD. It is a leading health hazard around the world and is responsible for millions of deaths per year. The smallest air pollution particles are known as PM2.5, referring to particles 2.5 microns or smaller – there are about 25,000 microns in an inch. These particles can cause the most harm. The report found that, while exposure to coarse airborne particles was not associated with the risk of COPD exacerbations, both long-term and short term exposure to PM2.5 increased COPD symptoms and accelerated lung function decline. “The acute eects [on COPD] are largely mediated by the gasses, but the long-term and even more insidious components of air pollution are driven by these particles,” says Dr. Sin. “These particles can get inside the respiratory tract, inside the lungs, and stay there – not just for a few days, but weeks, months, sometimes years and decades – and can cause disruption to the normal immune system of the lung.” Exposure to air pollution causes acute and long-term symptoms In addition to playing a signicant role in the development of COPD, exposure to air pollution can exacerbate the condition for those who already have it, causing immediate and long-term eects. “The acute aect is fairly obvious – runny eyes, cough, sputum production, and shortness of breath. Patients living with COPD are more susceptible to these acute aects than individuals without COPD,” says Dr. Sin. These symptoms can potentially cause an acute lung event that can prompt emergency department visits, hospitalization, and, in severe cases, even death. Air pollution has impacts that go beyond the lungs, he adds. “Another important acute eect that is often unrecognized is that air pollution, especially the particles, has a terrible eect on the vasculature – the blood vessels.” COPD patients can have fragile or impaired blood vessels, and during instances of high air pollution, Dr. Don SIn “These particles can get inside the respiratory tract, inside the lungs, and stay there – not just for a few days, but weeks, months, sometimes years and decades.“ - Dr. Don Sin
46 Summer 2024 they are more likely to experience stroke, heart attacks, angina and other cardiovascular events. Air pollution may also raise a COPD patient’s risk for respiratory infections. Patients living with COPD are susceptible to even modest increases in air pollution levels. If the poor air quality continues, these symptoms will persist and their COPD will progress. They will become even more susceptible to hospitalization, stroke, heart attacks and even lung cancer. Air pollution does not just aect those with COPD The report also discusses how exposure to air pollution can stunt lung growth in children. Dr. Sin likens the lungs to a ower garden – in order to grow, they need nutrients and good air. Children whose lung growth is stunted will have small lungs forever, and because of that, will be more susceptible to developing COPD, lung cancer, and many other complications. While cigarette smoking is the leading cause of COPD, air pollution aects everyone in an area, not just the individuals who are smoking. It is also more constant and dicult to avoid. “With cigarettes, you have a very high exposure of toxins for a short period of time, and it’s dispersed throughout the day. Bad air is persistent – we have to breathe. Most people breathe 10 to 20 times every minute – it’s not as if we can stop breathing,” says Dr. Sin. Recommendations to improve health and air quality The report provides recommendations to benet the health of people living with COPD, including strong public health policies to reduce ambient air pollution and implementing air quality warning systems to let patients know when air pollution levels have exceeded an acceptable threshold. Individuals can take mitigation measures such as avoiding exercising outdoors when the air quality is bad, particularly during wildre season, and getting an indoor air purier with a HEPA lter. “What I would advise British Columbians to do is to check their air quality on a daily basis. If the air quality is considered intermediate or poor, to stay indoors, and to consider getting an air cleaner if they have chronic diseases like COPD, asthma or chronic heart disease,” says Dr. Sin. Wildres and other extreme weather events contribute to air pollution that worsens the eects on COPD, study nds. Photo: Courtesy Pixabay. “Bad air is persistent – we have to breathe. Most people breathe 10 to 20 times every minute – it’s not as if we can stop breathing.” - Dr. Don Sin.
47 Summer 2024 New research suggests that a low-carb, high-fat diet, similar to the popular ‘keto’ diet, may be linked to increased levels of “bad” cholesterol and a higher risk of heart disease. The study, led by Dr. Iulia Iatan with the Centre for Heart Lung Innovation and the Healthy Heart Program Prevention (HHPP) Clinic at St. Paul’s Hospital, and Dr. Liam Brunham, senior author and Medical Lead of the HHPP, is one of the rst of its kind to examine the association between this type of diet and cardiovascular outcomes. This research was presented at the American College of Cardiology’s Annual Scientic Session together with the World Congress of Cardiology earlier this week. A pattern of high cholesterol after following this diet Drs. Brunham, Iatan and colleagues kept seeing patients come into their clinic with high cholesterol levels – and occasionally even heart disease – after following a low-carb, high-fat (LCHF) diet. “They would come in, very young but with very high cholesterol after following this diet, despite prior normal levels” says Dr. Iatan. The researchers wanted to investigate this potential connection with cardiovascular disease. The study they conducted compared 305 people eating a LCHF diet with around 1200 people eating Does a low-carb, high-fat diet increase your risk of heart disease? Research shows that a keto-like diet may be linked to higher levels of “bad” cholesterol. Photo: Courtesy Pixabay.
48 Summer 2024 a standard diet, using health information from the UK Biobank, which followed the participants for at least a decade. “We were interested to see if there was any relationship between this dietary pattern, cholesterol levels, and any risk of heart disease,” says Dr. Iatan. The study found that regular consumption of a self-reported diet low in carbohydrates and high in fat was associated with higher levels of ‘bad’ cholesterol and double the risk of cardiovascular events like blocked arteries, heart attacks and strokes. What is a low-carb, high-fat diet – and what makes it dierent from keto? For the purposes of the study, a low-carb, high-fat (LCHF) diet was dened as more than 45 per cent of total daily calories coming from fat, and less than 25 per cent coming from carbohydrates. While the LCHF diet used in this study has been described as “keto-like,” it doesn’t meet the technical criteria for the keto diet, which is even lower in carbs (less than 10 per cent) and higher in fat (more than 70 per cent). Read more about the keto diet in this Daily Scan article. The researchers chose to look at this broader LCHF diet because the keto diet can be very restrictive and dicult to maintain long-term. They also wanted to have enough participants on the LCHF diet to draw meaningful conclusions. Study suggests potential harms outweigh benets The study found that people on a LCHF diet had higher levels of low-density lipoprotein (LDL) cholesterol, commonly known as “bad” cholesterol, which causes a higher risk of cardiovascular events. The LCHF diet doubled the risk of cardiovascular events such as blocked arteries, heart attack and stroke, after adjusting for obesity, diabetes, high blood pressure and smoking. 9.8 per cent of people on the LCHF diet experienced a new cardiac event, compared with 4.3 per cent of those on a standard diet. LCHF diet participants’ total fat intake was higher in saturated fat and had double the consumption of animal sources compared to the control group. “What’s interesting to mention is that, when you look at the percentage of people in each dietary Dr. Liam Brunham, senior author of the study.
49 Summer 2024 group that would be dened as having severe high cholesterol, we found that approximately six per cent of patients in the standard group had very high cholesterol, versus eleven per cent in the low-carb, high-fat group,” says Dr. Iatan. Severe high cholesterol is dened as having LDL-cholesterol above 5.0 millimoles per litre, or 190 milligrams per decilitre. This is also the group in whom the greatest increase in cardiovascular risk was observed. Not all LCHF diets are the same The study’s ndings also suggest that not everyone responds to a LCHF diet in the same way. Cholesterol levels rise on average, but that can vary in individuals depending on several underlying factors, including genetics, length of time on the diet, and dierences between foods chosen in place of carbs. While LCHF diets heavily rely on fats, those fats can come from healthy unsaturated sources like avocadoes, tofu, nuts, seeds, and olive oil, or from saturated fats like lard, butter, coconut oil, whole-fat dairy milk and cheese, and mayonnaise. “What we think is important, is to make sure that when we restrict the carbs, we replace them with healthy fats – nuts, seeds, sh, and plant-based alternatives – rather than just saturated fats,” says Dr. Iatan. Still more to learn Because this study was observational in nature, it can only demonstrate an association between the diet and an increased risk for major cardiac events – it doesn’t denitively prove cause and eect. Further research is needed into the potential risks and benets of LCHF diets, especially considering their popularity. If someone wants to try a LCHF diet, Dr. Iatan recommends that they contact a medical provider, keep track of their cholesterol levels, and try to address any other risk factors for heart disease. “If someone does go on a low-carb, high-fat diet, they should be aware that it could lead to an increase in their levels of cholesterol,” she says. Dr. Iatan spoke with CNN about this research. You can watch the video here. Dr. Iulia Iatan speaks about the research on CNN. “If someone does go on a low-carb, high-fat diet, they should be aware that it could lead to an increase in their levels of cholesterol.” - Dr. Iulia Iatan.
50 Summer 2024
51 Summer 2024 An event to dream up innovative approaches to wound care has prompted an idea to bring a pop-up wound clinic to underserved people, right in their communities. Skunkworks: Hacking Wounds recently gathered diverse minds to come up with ideas to target this area. Providence Research organized the event. Getting out of your sandbox The term ‘skunkworks’ originated in the 1940s as an alias for an American engineering lab that worked on top-secret and innovative programs at Lockheed Aircraft Corporation. Today, ‘skunkworks’ describes a project developed by a loosely structured group of people who identify issues and Brainstorming ways to bring wound care to those in need Brainstorming at Skunkworks: Hacking Wounds resulted in an idea to bring pop-up clinics right to people underserved by health care.
52 Summer 2024 pilot creative solutions. The wound-clinic team included people from several disciplines, from Providence Health nurses to students from UBC’s School of Biomedical Engineering. “We kind of put a dream team together without knowing it,” says Lisa Maks, diabetes clinical nurse specialist with Providence Health. “What really intrigued me about Skunkworks was bringing together people from dierent specialties and backgrounds, who shared the common goal of making a change,” says Theresa Khosrovi, a clinical nurse educator, also at Providence. Each member brings dierent skills Because they had unique experiences and skills, the participants learned from each other. “My main takeaway is how helpful it is to step outside of your regular sandbox and to toss around ideas with other professions,” says Aggie Black, Director, Health Services and Clinical Research and Knowledge Translation at Providence Health. The team took on the problem of how to help people underserved by the health care system to take care of their acute and chronic wounds. Maks originally brought the problem pitch forward. She’s worked in diabetes care for 18 years, and has seen the impact that wounds have on patients’ quality of life. As soon as she heard about Skunkworks, which was an opportunity to work on a solution to possibly prevent wounds from escalating, she was in. Repeat visits from patients who lack support Working in the acute medicine unit at St. Paul’s Hospital, Khosrovi would see patients returning with unhealed wounds due to a lack of support. “That made me think, what I could do to solve this never-ending cycle so that these people could actually fully heal and live their lives to the fullest?” The team pitched a pop-up clinic that would bring wound care directly to underserved populations. It would oer to-go kits for those who can’t wait or would rather do the dressing themselves. The team Aggie Black. “My main takeaway is how helpful it is to step outside of your regular sandbox and to toss around ideas with other professions.” - Aggie Black.
53 Summer 2024 would bring care where people already are by partnering with existing services like shelters and soup kitchens. During the event they received feedback from patient partners and mentors that this is an important and unmet need. Benets of treating wounds early By catching wounds in early stages, they would prevent hospital admissions, readmissions, and escalations of care like amputations. The pop-up clinic is not meant to be the ultimate solution, but to gradually get everyone in need connected with the health care system and to more permanent services. “Ideally, the goal would be to work ourselves out of a job,” says Black. “Until we have a perfect health care system, where everyone feels welcome and respected, we sometimes need to take care to people where they are.” Focusing on a service, not an app Unlike many of the other Skunkworks pitches, their idea was not about a new technology, app or device, but about a human resource-based service. Because their idea didn’t fall neatly into the parameters of the two available awards – the Technology Accelerator award or the Research and Innovation award – the team doubted they would win either award or the funding that would come with them. Then the judges announced that they had created a new and third award, complete with a year of funding – the Social Justice Award. And the pop-up clinic won. “Hearing our project get announced as the winner denitely made us feel appreciative and grateful to work in a health organization that truly supports social justice,” says Khosrovi. Caring for patients “still falling through the cracks” “I felt like the judges really saw what we were trying to get them to see – that this is a gap, and that we can provide an innovative solution, evaluate, and see if it makes a dierence,” says Black. “Part of the social justice mission is taking a hard look at how we’re doing things, and how we could do them better. Who are the patients that are still falling through the cracks?” Looking Back and Looking Forward Skunkworks: Hacking Wounds was a unique way for people from across disciplines to put their heads together and come up with creative solutions to problems surrounding wounds. The ideas that came from this event were innovative and sparked inspiration across the board. “It was a fabulous experience that I would do again in a heartbeat,” says Maks. Brainstorming at work
54 Summer 2024 Aging is inevitable but how do we live well while we age? There are complex challenges surrounding aging that require creativity, collaboration and innovation. The third annual Skunkworks event, Hacking Aging, united researchers, health care professionals, caregivers, patients, students and external partners to collaborate on solutions to address these challenges and improve the lives of older people. Super senior Jim Pattison a judge As part of the event, each team would brainstorm ideas then get three minutes to pitch its project to a panel of judges. This year’s panel included Johny Bassan, Director, Internet of Things, BCIT, Sarah Lubik, SFU Director of Entrepreneurship, Jason Elliot, Master of Digital Media (MDM) and Pre-MDM Faculty, Centre for Digital Media, Sean Lumb, Skunkworks: ideating how to help seniors age well Dr. Darryl Knight speaks at Skunkworks: Hacking Aging.
55 Summer 2024 Interim Managing Director of entrepreneurship bv@UBC, and Brian Simmers, Providence Health Care Chief Financial Ocer and Vice President, Health Informatics and Corporate Development. Super senior Jim Pattison, the legendary Vancouver businessman, was a special guest judge. Record number of attendees Hosted by Providence Research in partnership with St. Paul’s Foundation, Skunkworks is a unique innovation event series designed to facilitate solutions to complex health care problems. The term “skunkworks” originated in the 1940s as an alias for an American engineering lab that worked on top-secret programs at Lockheed Aircraft Corporation. Today it describes a project developed by a group of people who identify issues and pilot solutions. This year’s event was presented by the Centre for Aging + Brain Health Innovation (CABHI) and held in collaboration with the Discover, Learn & Innovate for Impact Physician Advisory Committee and Providence Health Innovation, Research + Engagement (PHIR+E). Around 120 people attended Skunkworks: Hacking Aging, more than any previous year. Broadening perspectives on aging through design thinking, lightning talks Skunkworks is framed around design thinking, an approach to problem solving anchored in human-centred design. Marlies van Dijk and Josh McCutcheon from The Pivot Group design rm facilitated the event, leading a series of design thinking activities to explore the challenges surrounding aging. Through these, teams of participants developed “How might we?” questions to frame the problems they would be “hacking.” Speakers gave lightning talks to inspire and energize participants. Health Futurist Zayna Khayat from Deloitte Canada gave a virtual presentation from Ontario on the future of aging. She spoke about the three layers of change – technology, policy and people. Technology creates what is possible, policy dictates what is permissible, and people dictate what is operable. She encouraged participants to focus on policy and people – as health care practitioners, they have direct experience with aspects that people running technology companies usually lack. Mr. Jim Pattison at Skunkworks: Hacking Aging.
56 Summer 2024 Older adults as co-creators of new care, not passive recipients Jim Mann, a researcher, author and volunteer who is engaged in reducing stigma around dementia, provided unique insights from the perspective of a person with Alzheimer’s. He emphasized that it is important to view older adults not as passive recipients of new forms of care and innovation, but as co-creators. Dr. Lillian Hung, the founder and head of the UBC Innovation in Dementia and Aging (IDEA) Lab, spoke on research innovations in the elds of dementia and aging. The UBC Idea Lab had an interactive display showcasing their Lovot robots, Mango and Kiwi. The Lovots are mobile social robots that the lab is testing to determine if they can improve the quality of life for people with dementia. Patient partners have vital role A key theme that emerged throughout Skunkworks: Hacking Aging was the importance of listening to patient populations in order to understand both their healthcare needs and who they are as people. That is why the participation of patient partners in events like this is vital. Several patient partners aliated with the Patient Voices Network were part of this year’s event and made contributions, not just as mentors oering their unique insights and perspectives, but as genuine participants in the conference. “I hadn’t been to a conference in over 10 years, and this conference sort of picked me up and took me into the 21st century. It was an absolute mind-blower, in terms of my own personal learning,” says patient partner Margaret Emmet. Prototyping and pitching solutions On the second day of the event, the teams created ‘prototypes’ of solutions to their “how-might-we” questions. Prototyping involves designing an early version of a project that provides an idea of what it is, while still letting the creators quickly pivot and toss away ideas that are not working. Award winners The Technology Accelerator Award is presented to the idea that involves the best use or adaptation of technology. This was awarded to Mango and Kiwi appear at Skunkworks. They are mobile social robots that could help improve the quality of life for people with dementia.
57 Summer 2024 Team Six for their project, “The Communications Interface Overall Care Solution (CIOSC),” a system that would increase eciency in long-term care homes through allowing patients, family members and health-care providers to access patient information through a voice-activated touchscreen. The Research and Innovation Award goes to the idea that seeks to advance research, knowledge and ideas that could result in products, services or practices that will positively impact the older adult population. This was awarded to Team Eight for their project, “Know-Well,” which would support care teams in understanding who a patient is, when they might not be able to communicate for themselves. A QR code on a wristband would be connected to a database of signicant information lled out by the patient’s family. Continuing a tradition that began at Skunkworks last year, PHC spontaneously funded a surprise third award, the Operational Impact Award, which went to Team Two for its “Older Adult Liaison” project. It can be challenging for older adults to navigate the emergency department, and family members cannot always be there to support them. The Older Adult Liaison would help older adults through the system, assisting with navigation, answering questions, and working with ED sta to streamline the ow of care. The panel of expert judges at Skunkworks: Hacking Aging
58 Summer 2024 Providence Health Innovation, Research + Engagement (PHIR+E), a part of and the link between Providence Research and Innovarium, makes vital connections between researchers and other members of the Providence Health Care community and the resources they need to innovate. PHIR+E supports the creation and implementation of new solutions to healthcare challenges in real-world settings. Enabling innovation through connection PHIR+E is an integral part of Innovarium, Providence Health Care’s innovation engine that unites various complementary research elements, creating an environment that provides resources and support to accelerate innovation. The PHIR+E team specializes in forming strategic partnerships and helps bring together a diverse range of stakeholders, including individuals, academic institutions, and government and industry partners. In this way, PHIR+E connects resources, opportunities and platforms to advance innovative medical research ideas. PHIR+E amplies PHC’s position as a leader in healthcare innovation, building visibility and interest amongst peers, stakeholders, and other potential collaborators, while helping to retain and attract the best minds. It hosts workshops, networking events, competitions and other programs that provide opportunities for researchers, clinicians and other innovators to acquire the skills and experiences vital to develop innovative ideas and healthcare solutions. It also connects them with experts in areas such as ethics, contracts and nance. “PHIR+E was established to maximize the impact of research at PHC. By establishing these bidirectional partnerships between our researchers and external stakeholders, and through working in collaboration with the other components of Innovarium, PHIR+E enables research translation and a greater return on investment,” says Dr. Darryl Knight, President, Providence Research, Vice-President, Research & Academic Aairs, Providence Health Care, Associate Dean, Faculty of Medicine, University of British Columbia. PHIR+E: Advancing Innovation with Providence Research PHIRE+E logo Dr. Darryl Knight speaks at Skunkworks: Hacking Aging
59 Summer 2024 PHIR+E in Action A signicant part of the initiative involves hosting and organizing novel events and opportunities meant to spark new ideas and accelerate healthcare solutions. PHIR+E’s agship event, Skunkworks, brings together a diverse range of participants to address local issues that have global signicance, such as Pain, Wounds and Aging, themes of previous Skunkworks. This year, Skunkworks’ theme is Chronic Disease. Skunkworks is an opportunity for people from dierent disciplines to collaborate and brainstorm creative solutions, presenting their ideas to a panel of judges. Winning teams participating in the Skunkworks competition receive funding, sector expertise, and support to make their proposed solution a reality. You can learn more about the event here. “It was wonderful to meet so many colleagues from other parts of the system,” says Dr. Sammy Chan, a participant in Skunkworks: Hacking Aging. “The wide range of perspectives made the solutions so much richer and well thought out.” PHIR+E supports ideas originating at Skunkworks by providing funding or by connecting the teams with needed resources. For example, the Mend & Tend pilot program, which brings wound care to residents of Vancouver’s Downtown East Side, originated at Skunkworks: Hacking Wounds in 2022. Another project in development is the Oasis Connect App, which is designed to enhance care delivery and family engagement within Canadian long-term care homes. PHIR+E enabled the team that pitched the idea at Skunkworks: Hacking Aging in 2023 to develop a prototype with support from the Centre for Digital Media. Maximizing opportunities at the CSRC The new state-of-the-art Clinical Support and Research Centre (CSRC) at the new St. Paul’s Hospital will see scientic breakthroughs translated into real-world health care, extending the continuum of care to ensure patients get the right care, in the right place, at the right time. The CSRC will include infrastructure for cutting-edge technology such as 3D bio-printing, data, and analytics which will contribute to B. C’s positioning as a global hub in life sciences. Building on our culture of innovation PHIR+E is dedicated to cultivating an environment where innovation thrives. The program works to clear the path to discovering and implementing new solutions, and to empower innovators in the process of rening their ideas and achieving breakthroughs. PHIR+E supports innovations developed by Providence Research and PHC clinicians, connecting them with the resources needed for implementation. Along with the other elements of Innovarium, including Providence Health Care Ventures and Ideas Forward, PHIR+E plays a pivotal role in advancing innovation at Providence Health Care. To learn more about PHIR+E, please visit our website. Questions? Contact Ivone Martins Executive Director, Providence Health Innovation, Research + Engagement (PHIR+E) IMartins@providencehealth.bc.ca A rendering of the Clinical Support and Research Centre.
60 Summer 2024 An app to enhance care delivery and family engagement within Canadian long-term care homes has been developed in a collaboration between Providence Health Innovation, Research + Engagement (PHIR+E) and Centre for Digital Media (CDM). The app, called Oasis Connect, was one of the winning pitches at Skunkworks: Hacking Aging that received funding and support from PHIR+E to help make the solution a reality. Skunkworks and CDM: Collaborating to solve complex problems PHIR+E advances important research ideas by making vital connections between researchers and the resources they need to innovate, supporting the creation of new knowledge and solutions to healthcare challenges, and implementing those solutions in real-world settings. Skunkworks is a unique innovation event series, hosted by Providence Research and PHIR+E in partnership with St. Paul’s Foundation, which brings together a diverse range of participants to address pervasive health issues with global signicance such as Pain, Wounds and Aging, the themes of previous Skunkworks. This year, the theme is Chronic Disease. Teams made up of people from a range of disciplines work together to ideate solutions to complex health care problems. The winning teams receive funding and support from PHIR+E to develop their project. Oasis Connect won the Technology Accelerator award at Skunkworks: Hacking Aging in 2023, which was presented to the idea that involves the best use or adaptation of technology. Skunkworks has partnered with CDM for more than three years to help develop some of these winning projects. Comprised of students from various professional backgrounds, CDM collaborates with academic institutions, industry groups and the community to create world-leading digital media programming that focuses on addressing society’s most important challenges. For this project, the Sunnyside team from CDM used their expertise in coding and UI design to develop the Oasis Connect app. CDM additionally provided workspace, project advice, and other PHIR+E and Centre for Digital Media bring a solution from Skunkworks: Hacking Aging to life An example of the Oasis Connect app’s home page
61 Summer 2024 resources. “Our solution is meticulously designed with a user-centric approach to signicantly enhance the experience of residents, families, and sta within LTC facilities,” says Hannah Meng, a CDM Master of Digital Media student and the project manager for Oasis Connect. App aims to address challenges in long-term care There are many challenges faced by Canadian long-term care (LTC) homes face, including stang shortages, inecient call bell systems, and limited family connection. Oasis Connect aims to address these challenges with a comprehensive platform that blends resident-focused solutions with data-driven insights for care providers, oering a multifaceted solution to optimize long-term care delivery. The project additionally aims to improve work satisfaction and eciency, as well as to identify stang gaps. The Sunnyside team designed the app to provide an intuitive and aesthetically pleasing user experience that is tailored to be accessible for seniors. Oasis Connect follows three main approaches to addressing these problems: data-driven resource management, family-centric communication, and personalized resident interactions. The app facilitates data-driven resource management with a system that categorizes “call bell” requests into easily understandable types, showing LTC managers breakdowns of residents’ needs in real time. This enables informed decision-making about stang and resource allocation. “By identifying trends and volumes, it provides critical insights into stang needs - whether there is a need to increase roles or optimize existing resources. This targeted approach helps eciently allocate sta and enhances care response times,” says Meng. Statistics show that a signicant portion of LTC workers’ time is spent in communicating with other sta about residents’ wellbeing, and in communicating with residents’ families, who often desire more insight into residents’ routines and activities. With Oasis Connect, a dedicated tablet in each resident’s room acts as an informational hub for families, providing information about care updates, outings, doctor visits, routine checks, and activity participation. This system makes information more accessible to families without the need for a direct conversation with sta, freeing up time for sta to focus on critical resident needs. The app also streamlines internal communications among sta with a system that allows them to add key care events to a resident's care prole, helping to transmit important information across shifts. The team presents their pitch at Skunkworks: Hacking Aging. From left to right: Jennifer Gibson, Azra Sharma, Sara Suntano, Ryan Yeung, Maria Boteros, Tulia Ferreira, Je Lorz, Danielle Richards
62 Summer 2024 Oasis Connect facilitates personalized resident interactions through an “About Me” section, featuring proles lled out by residents and their families about the resident’s passions, interests, and history. Sta will be able to use these proles to help get to know residents on an individual basis, enabling more meaningful conversations and contributing to the provision of person-centred care. “Overall, our solution streamlines communication, enhances operational eciency, and fosters a more connected and transparent care environment, signicantly improving the quality of life and satisfaction among all stakeholders in the LTC setting,” says Meng. “Our collaboration with Providence was vital, as it provided a unique opportunity to revolutionize healthcare delivery in public long-term care facilities.” Collaboration was a ‘remarkable experience.’ The Oasis Connect app project, which utilizes innovative technology to help improve care in LTC homes, was made possible by the collaboration between PHIR+E, the team from Skunkworks, and the Sunnyside team from CDM. “Working with the CDM team was a remarkable experience. The innovation and creativity of the Sunnyside team produced a product that has the ability to shift and improve workows of sta in long-term care homes, and thus improve the quality care for residents,” says Danielle Richards, Manager of Clinical Excellence and Program Education at Providence Health Care and a member of the Skunkworks team that originally pitched the project. “The team took the initiative to complete visits to multiple care homes, to further their appreciation and understanding of long-term care, the challenges faced by sta, and the lived experiences of families.” Supporting the ideas originating at Skunkworks and connecting the teams with the resources they need to follow through with these projects, is one of the ways that PHIR+E is facilitating innovation at Providence Health Care. “PHIR+E was established to maximize the impact of research at PHC. By establishing these bidirectional partnerships between our researchers and external stakeholders, and through working in collaboration with the other components of Innovarium, PHIR+E enables research translation and a greater return on investment,” says Dr. Darryl Knight, President, Providence Research, Vice-President, Research & Academic Aairs, Providence Health Care, Associate Dean, Faculty of Medicine, University of British Columbia. Even more innovative solutions will be created this year at Skunkworks: Hacking Chronic Disease on November 14 and 15, 2024. “The innovation and creativity of the Sunnyside team produced a product that has the ability to shift and improve workows of sta in long-term care homes, and thus improve the quality care for residents .“- Danielle Richards.
63 Summer 2024 This isn’t your typical conference or seminar. Building o the success of Hacking Pain, Hacking Wounds and Hacking Aging, we hope our fourth Skunkworks event, Hacking Chronic Disease, will be a catalyst for innovation. There are many challenges around chronic disease waiting to be solved, but often researchers, health care professionals, caregivers, and patients do not have a chance to collaborate and share expertise to ideate together. Skunkworks brings multidisciplinary teams together and empowers them with mentorship and rapid problem solving tools to address challenges related to chronic disease management and prevention. Skunkworks: Hacking Chronic Disease Uniting through innovation to solve the most pressing chronic disease challenges
64 Summer 2024 Meet Our Team
65 Summer 2024 Connect with us!