Improving systems of services to people with complex and concurrent mental disorders and substance use disorders

Project number: 
18-123
Approval date: 
Monday, October 1, 2018
Principal Investigator: 
Small,William
Institution: 
Simon Fraser University (SFU)
Funding Agency: 
Canadian Institutes of Health Research(CIHR),Michael Smith Foundation (MSFHR)
Datasets requested: 
Consolidation - demographic (Ministry of Health)
PharmaNet
NACRS
BCMHSUS-PHSA
consolidation - census geocodes
Hospital Separations (BC Ministry of Health)
Medical Services Plan (BC Ministry of Health)
Deaths (BC Vital Statistics Agency)
Vancouver Coastal Health Authority
Consolidation file (BC Ministry of Health)
Research objective: 

The overall project objectives (as outlined in the original proposal) are to:

i. Use service utilization databases to conduct a longitudinal study of the system flow for individuals with complex concurrent disorders (CCD) when interacting with healthcare and police services
ii. Examine the impact of Access Assessment Centre, a novel, centralized access to mental health/addictions treatment program, on system flow of patients/individuals with CCD through existing healthcare and police
services
iii. Examine the impact of The HUB integrated service delivery model, that provides both rapid assessment and transition services for individuals with CCD in one location, on system flow of patients/individuals with CCD through existing healthcare and police services
iv. Estimate the difference in public costs for health and policing service utilization as a result of these two programs.

NOTE: The launch of the HUB has been delayed to September 2017 and so objectives iii. and part of objective iv. as outlined in the original proposal cannot be fulfilled through analysis of data requested through this DAR.

Under each objective we seek to answer the following specific research questions:
i.i. How do measures of complexity and concurrence operationalized in administrative health data relate to frequency of emergency department (ED) use)?
-We expect that presence of a concurrent disorder increases frequency of emergency department use.
-We expect that other indicators of complexity (severity of mental health and substance use disorder, previous use of tertiary mental health and substance use treatment, previous involuntary hospitalizations, presense of concurrent chronic health conditions) predict high use of emergency deparment.

i.ii What are patterns of service use before and after ED vists for mental health and substance use disorder? How does this differ for patients with CCD?
-We expect patients who receive care in the ED will have had previous contact with primary care, outpatient psychiatric care, community mental health and substance use disorder treatment, and medication for mental health and substance use disorders. We expect that patients with CCD will have less consistent contact with primary care, outpatient psychiatric care, and community mental health and substance use disorder treatment.

iii.i How do patterns of service use following ED admission differ for patients exposed and unexposed to the AAC?
-We expect that patients exposed to the AAC will have greater contact with primary care, outpatient psychiatric care, and community mental health and substance use disorder treatment, but fewer subsequent emergency department visits and hospitalizations.
- contact with the AAC will be determined through the VCH Community Mental Health database
iii.ii Does the impact of the AAC differ for patients with CCD?
-We have no a priori hypothesis about whether effects will differ for patients with CCD.

iii. We will NOT be able to address objective iii (Examine the impact of The HUB integrated service delivery model) with the requested data, due to the delayed launch of that service.

iv.i How do public costs of health care service use following ED admission differ for patients exposed and unexposed to the AAC?
-We have no a priori hypothesis about how public costs of health service use will differ.
iv.ii Does the impact of the AAC with respect to health care costs differ for patients with CCD?
-We have no a priori hypothesis about whether effects on cost will differ for patients with CCD


Page last revised: December 5, 2018