A cornerstone of our work at the Institute for Better Health (IBH) is building data infrastructure to better understand the health of our population. This past year, Principal Investigators, Dr. Laura Rosella (Stephen Family Research Chair in Community Health and Scientist), Dr. Ian Zenlea (Clinician Scientist and Pediatric Endocrinologist), Dr. Dianne Fierheller (IBH Investigator and Social Worker) and their research team partnered with the Anti-Black Racism and Systemic Discrimination Collaborative (ABRSD) to explore how we can better collect data, measure the current state and create a baseline for the future of health equity in our community. This project is using a community-based participatory research approach that includes a community engagement council comprised of researchers, community members, and leaders from the ABRSD. Currently, there is limited data and linkages in health information databases (e.g. hospital health information systems, in our community and provincially) resulting in a lack of insights into the socio-economic and race-based data that would help deepen our understanding of inequity. We cannot see inequities in health when we do not collect the necessary information to understand and evaluate them. With the support of an initial grant from the Temerty School of Medicine at the University of Toronto, the research team in partnership with ABRSD Collaborative are exploring how we can better collect and steward the use of this information to better understand who in our community accesses and does not access primary care services. The team has started by exploring these questions in our primary care community and are focused on determining the appropriate information to collect about our patients and community regarding social determinants of health. Through workshops and dialogue with health care providers and key community members and experts, the team is also exploring how to build the necessary data infrastructure to collect this information. The team is also exploring how they can create the necessary cultural safety for patients and families to share this information. In the next phase of work, the team will implement this work and explore the possibilities in other sectors.

The AI and Deployment Evaluation (AIDE) Lab, led by Dr. Benjamin Fine (Clinician Scientist, Radiologist) and his team, recently completed one of the world’s largest external validations of a commercially developed chest x-ray disease classification tool in partnership with a third party vendor and Supercluster Canada. Embedded within IBH, the AIDE Lab is focused on bridging the gap between artificial intelligence (AI) and its real world applications in health care to equitably improve health outcomes for patients. Many of today's AI algorithms fail in the real world because they are developed using data that is not representative of the population in which the algorithm will be deployed. This leads to inaccurate or incomplete ability for the algorithm to function optimally. For example, a commercial AI algorithm deployed in a US health care system used to assign risk scores to patients was found to be biased against Black patients. At a given risk score, Black patients were considerably sicker than white patients, which can be attributed to existing biases in the data used to develop the algorithm. In order to better evaluate and deploy meaningful AI into our health system, the AIDE Lab collaborates with partners to evaluate externally developed models on our hospital imaging and Electronic Medical Record (EMR) datasets. As one of the largest data sets in Canada and with some of the most diverse community and health data information reflective of the large, growing and diverse population of Mississauga, the team is better able to assess the AI’s ability to work meaningfully in real work environments. The Lab is currently working on many AI contract research projects with external academics and commercial developers to validate models on our hospital data. A full-time computer science trained associate scientist will be joining the AIDE Lab this summer to develop methods, teach trainees and share learnings generated by the Lab. With enriched data and information related to the make-up of our community, we will continue to elevate and advance our ground-breaking efforts in collecting and using population health data to provide more inclusive care for our diverse community.

Among many notable partnership projects across the Institute for Better Health (IBH), Dr. Robert Reid (Hazel McCallion Research Chair in Learning Health Systems, Chief Scientist and SVP Science) is co-leading the Rapid-Improvement Support and Exchange (RISE), a key partnership initiative between IBH, McMaster Health Forum and Ottawa Hospital Research Institute to support the development and maturation of Ontario Health Teams (OHT) across the province with the goal of integrated care for the community. As Population-Health Management (PHM) is central to the success of OHTs, Dr. Reid and his team are leading the development and delivery of an evidenced-based program to enable OHTs to implement a PHM approach to care. To date, the RISE PHM program has advanced the exchange of knowledge and learnings in Ontario by collaborating and partnering with experts (including individuals with lived experience) in the delivery of webinars and providing coaching to 39 OHTs using evidence-based coaching and improvement methods. Moving forward, the team will continue to support OHTs across the province and will be onboarding 8 additional OHTs.

This past year, THP played a central role in supporting our province’s pandemic response by launching and deploying a hospital-based COVID-19 Vaccine Program and one of the largest single site vaccine programs in Canada to improve the health of the community we serve and beyond. Many teams across our organization, including IBH played a pivotal role in leading the Vaccine Program. IBH team members led the design and operations of the program and managed relationships with key community partners and organizations to ensure the highest priority populations, including essential workers and caregivers were vaccinated in a timely and efficient manner. We collaborated with many community partners including Peel Public Health, First Responders, University of Toronto Mississauga and others to administer and increase the uptake of the vaccine in our community. With the collective expertise of internal teams across THP and our external community partners, the Vaccine Program was administering 4,200 vaccines a day at its peak, with more than 528,000 vaccines administered to-date. Most recently, the COVID-19 Vaccine Program was awarded this year’s Patti Cochrane Partnership Award at THP, which recognizes the significant contributions of THP staff who have engaged in a joint project where the outcome has demonstrate significant benefits to our community. The Vaccine Program exemplifies our values of compassion, excellence and courage by demonstrating that the strength of partnerships and teamwork allows us to overcome challenges and achieve together what would not be possible alone, demonstrating that we are truly better together.

We understand that our community represents diverse perspectives and experiences and we aspire to create a collaborative environment by applying human-centred approaches to engage, empower and partner with patients, family and community mem­bers at each step of the research and innovation process to co-create meaningful solutions. Principal Investigator Dr. Kerry Kuluski (Dr. Mathias Gysler Research Chair in Patient and Family Centred Care and Scientist) and her team are leading a CIHR funded qualitative study to examine the experiences of individuals after leaving the hospital during COVID-19, and exploring how discharge from the hospital can be more seamless in the future. The research team will interview patients, family members, care providers and system decision-makers across Ontario who have been impacted by rapid hospital discharge to understand their experiences, gaps and identify opportunities to work together to create better transitions of care. In addition, Principal Investigator Dr. Susan Law (Senior Scientist), in collaboration with a diverse and multidisciplinary team, is leading two Canadian Institutes for Health Research (CIHR) funded projects to gather ​collections of individual patient stories from across Canada, using audio and video recording that reflect the diversity of experiences with long-COVID and women’s experiences of heart failure. Both projects include the engagement of individuals with lived experience as partners, health care providers and community-based organizations. The recorded stories will be presented in a short film, and shared on the research program’s open access website to allow patients and providers to learn from others, and provide experiential evidence to inform the design of current and future health services. Furthermore, Principal Investigator, Dr. Elizabeth Mansfield (Scientist) and her multidisciplinary team are leading a CIHR funded project that engages young adults with lived experience of mental health concerns and their families/friends from diverse communities (e.g. racialized, different ethnocultural backgrounds, and/or gender/sexual identities) to create tailored solutions to improve mental health services and supports in Peel. To date, the project team has created a community advisory board to bring co-researchers and local stakeholders together to participate in the study design. In the next phase of work, the team will launch two online photovoice workshop series, an arts-based participatory method, one series for young adults and an additional series for families and friends to help inform co-design and knowledge sharing activities.

With the collective expertise of our interdisciplinary team, we are exploring novel and creative solutions to address the challenges facing our health care system. This past year, many researchers and innovators across IBH received national recognition for demonstrating scientific excellence and their commitment to improving the health of our community.

Dr. Walter Wodchis (Research Chair of Implementation and Evaluation Science and Senior Scientist) was recently awarded the CIHR-IHSPR 2021 Barer-Flood Senior Career Prize in Health Services and Policy Research for a pan-Canadian study, which recognizes and supports research excellence and is given to the highest ranking senior-career investigator in CIHR’s Project Grant Competition whose work aligns with the IHSPR’s mandate of improving the health and quality of life of all Canadians. The pan-Canadian study is led in partnership with CarePoint Health and seeks to provide team-based care options for patients and physicians who are not already part of a team. This is highly relevant and impactful within Mississauga, where there are relatively few team-based models of care. Dr. Laura Rosella (Stephen Family Research Chair in Community Health and Scientist, Canada Research Chair in Population Health Analytics and Canada’s Top 40 under 40), became a member of the College of New Scholars of the prestigious Royal Society of Canada, the first national system that recognizes leaders from multidisciplinary backgrounds for their intellectual leadership. This prestigious invitation is given to leading intellectuals, scholars and researchers to collectively mobilize and address issues that are critical to Canada and Canadians. Dr. Terence Tang (Clinician Scientist and Internal Medicine Specialist) was recognized as a COVID Hero by the City of Mississauga for his dedication to improving the health of our patients and community. Dr. Laura Desveaux (Scientific and Learning Health System Program Lead) was recognized as a Women Leader in Digital Health by Digital Health Canada. And at this year’s THP Patient Safety Week, members of the IBH team including Delilah Ofosu-Barko (Director, IBH Operations), Kylie Walcott (Research Ethics and Quality Assurance Officer) and Jeff D’Souza (Research Ethics Board Coordinator) received an honourable mention as members of the THP Research Ethics Leadership team, for an Experience Quality Award for their project, entitled “Strengthening our Partnerships Between THP REB and our own Research Community,” which focused on enhancing the relationship between the THP Research Ethics Board and the Research Community to better facilitate ethical research.

One approach we are taking to advance our goal of shaping a more inclusive tomorrow is by meaningfully engaging and participating in knowledge sharing through presentations and publications locally, nationally and internationally. This past year, Dr. Lisa McCarthy (Clinician Scientist and Pharmacist) presented her work on lessons learned from efforts to understand and address side effects resulting in prescribing cascades, at the 27th European Association of Hospital Pharmacists Congress in Vienna. Dr. Matthew Schlenker’s (Clinician Scientist and Ophthalmologist) work on exploring the risks of severe complicated adverse reactions for patients following prescription of an oral topical carbonic anhydrase inhibitor was featured in JAMA Ophthalmology. IBH and THP’s work in leveraging cloud technology to improve the hospital’s capacity forecasting by analyzing bed-use data to identify patterns and better anticipate capacity requirements has been featured in local and national media outlets, as THP is one of the first health care organizations in Canada to apply cloud computing and analytics in this way and develop a predictive occupancy planning model.