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How can we improve health care for Canadians experiencing “transitions in care” to ensure they don’t fall through the cracks as they move through the health care system?

That’s the question two London researchers are aiming to answer, with the support of nearly $1.5 million in federal funding announced today at Western University's Schulich School of Medicine & Dentistry.
 
Peter Fragiskatos, MP for London North Centre, announced the funding boost on behalf of Federal Health Minister Jean-Yves Duclos, alongside Dr. Jane Rylett, Scientific Director of the Institute of Aging with the Canadian Institutes of Health Research (CIHR).  

“When a person experiences a transition in care, whether moving from surgery to rehabilitation or aging out of pediatric care, the quality of their care and their health can be at risk,” said Bryan Neff, Western’s acting vice president of research, who hosted the funding announcement. “With federal investments like this, Western will continue to lead the way in identifying how to provide the best possible care for Canadians while improving efficiency in the health-care system.”

Transitions in care happen when responsibility for a person’s care shifts between providers, institutions or sectors. Some groups, such as patients with complex medical conditions, Indigenous peoples, and new immigrants, are particularly vulnerable to poor outcomes during transitions.

People with diabetes – a complex, typically life-long condition – fall into this category, which is why London’s Primary Care Diabetes Support Program (PCDSP) was developed. The clinic, which is part of the Centre for Diabetes, Endocrinology and Metabolism at St. Joseph’s Health Care London, is based at St. Joseph’s Family Medical and Dental Centre. The program provides diabetes support and management for individuals with type 2 diabetes who don’t have a family doctor or who may have additional medical and social issues that make diabetes management particularly challenging. 

Maria Mathews, PhD, and her team at Schulich Medicine will evaluate the program to determine its impact on patient health, and on health-care providers, diabetes-related complications, and health system costs. 

“While this program has already been shown to deliver high-quality care, my team is examining its overall impact to determine whether this model could be expanded to other sites and to support other chronic conditions,” said Mathews, a professor in the department of family medicine. With the $895,000 investment in her research, Mathews will determine “how we can best provide high- quality care for people with chronic conditions in a way that supports their health, eases strain on family doctors, and creates efficiencies in the health care system.” 

Laura Brunton, PhD, an assistant professor at the School of Physical Therapy in Western’s Faculty of Health Sciences, received more than half a million dollars in CIHR funding.

Her team will examine a local program based at St. Joseph’s Parkwood Institute – called the Transitional and Lifelong Care Program (TLC) – that supports people with childhood-onset disabilities as they transition to adult care. This includes many patients with brain-based, neurodevelopmental conditions, such as cerebral palsy, spina bifida and developmental disabilities, as they move into adult care. 

“Many of these patients have experienced severe health inequities because of the gaps in care when transitioning from pediatric care to the adult sector,” said Brunton, also a physiotherapist at St. Joseph’s Health Care London and affiliate scientist at Lawson Health Research Institute. “We’re going to evaluate the TLC model as an intervention that provides transitional, lifelong care and reduces the barriers experienced.”

Roy Butler, president of St. Joseph’s Health Care London, said today’s announcement highlights the synergy and collaboration among these organizations.

“We are happy to hear that work being done by both Laura Brunton and Maria Mathews to improve patient care is being recognized through this funding announcement. The two areas these talented researchers will be studying are innovative and ground-breaking with compassionate, forward-thinking teams who provide highly acclaimed care to vulnerable patients.”

Fragiskatos emphasized the vital importance of funding this field of research, given that most Canadians will experience a ‘transition in care’ at some point.

“People living in Canada routinely experience transitions in care as they navigate the health system. The important research that will be done here in London and at institutions across the country will help develop meaningful approaches to make these transitions easier for patients and caregivers,” he said.

Local researchers were among 14 groups across Canada that received approximately $12 million in federal funding to improve continuity of care for Canadians through the “Transitions in Care” initiative, which is provided in partnership with the Azrieli Foundation, Mitacs, and the Rossy Family Foundation.

A new Lawson Health Research Institute study published in the journal Placenta has found a unexpected difference in the impact of pre-existing diabetes versus gestational diabetes on oxygen flow in the umbilical cord during pregnancy. 

Currently, tests done very close to the end of a high-risk pregnancy can’t reliably measure the full health of the placenta and baby. Women with complications like diabetes, high blood pressure and an elevated BMI (body mass index), among others, are therefore generally advised to induce labour before the 40-week mark.

“This study explored some of these high-risk pregnancies to better understand what occurs or changes in the placenta with the goal of eventually developing better tests,” says Dr. Barbra de Vrijer, High-Risk Obstetrician and Head of Maternal Fetal Medicine at London Health Sciences Centre and Scientist at Lawson. 

The St. Joseph’s Health Care London Perinatal Database, containing information on nearly 70,000 births between 1990 and 2011, provided the data for the study, including birth weight, placental weight and umbilical cord oxygen levels.

The study found that the number of blood vessels in the placenta (called vascularity) likely impacts oxygen in the umbilical vein, causing a slight increase in mothers with gestational diabetes, but a decrease in those with pre-existing diabetes.

Surprisingly, this new research indicates that hyper-vascularity in diabetic placentas (too many blood vessels) may actually decrease oxygen transfer, potentially leading to more risk to the baby.

“When there is an increase in placental vascularity, crowding of the blood vessels can occur constraining their effective absorbing surface area for oxygen uptake from maternal blood within the placenta,” says Dr. Bryan Richardson, Scientist at Lawson. 

Another finding of the study confirmed earlier research showing that in women with both pre-existing and gestational diabetes, who tend to have larger babies, the placentas were also disproportionately larger, which is an indicator of decreasing placental efficiency, or the birth to placental weight ratio.

While additional research is needed, Dr. de Vrijer sees hope in the development of newer tests that look at factors like metabolic markers – the results of which could help indicate if the placenta is insufficient and assist in decisions like whether and when to induce labour.

“There are new technologies that we are looking at studying moving forward,” says Dr. de Vrijer. “Our team is focused on continuing our research to better understand high-risk pregnancies with a goal of continuously improving care for pregnant individuals.”