A Pan-Canadian Vision and Strategy for Health Services and Policy Research. Phase 1: Building the Foundation

Acknowledgements

Led by the CIHR Institute of Health Services and Policy Research (IHSPR), this inaugural report represents a collaboration of 24 organizations committed to working together to develop a pan-Canadian vision and strategy for health services and policy research. In alphabetical order, we would like to thank the Alberta Cancer Foundation, Alberta Innovates-Health Solutions, Alzheimer Society of Canada, Arthritis Society, Canadian Breast Cancer Foundation, Canadian Breast Cancer Research Alliance, Canadian Diabetes Association, Cancer Care Ontario, Canadian Cancer Society, Canadian Foundation for Healthcare Improvement, Canadian Institutes of Health Research, Cystic Fibrosis Canada, Fonds de recherche du Québec - Santé, Heart & Stroke Foundation of Canada, Manitoba Health Research Council, Michael Smith Foundation for Health Research, New Brunswick Health Research Foundation, Newfoundland and Labrador Centre for Applied Health Research, Nova Scotia Health Research Foundation, Ontario Institute for Cancer Research, Ontario Ministry of Health and Long-Term Care, Parkinson Society Canada, Pediatric Oncology Group of Ontario, and the Saskatchewan Health Research Foundation.

Dr. Terrence Sullivan provided invaluable leadership of this initiative and report, with expert program management support from Melissa Heritage, data analysis from Laura Purves, research assistance from Sandra Hofstetter, and IHSPR staff support from Meghan McMahon and Kate Wood. We are also grateful for the support and guidance that Lillian Bayne and Mark Dobrow provided in the early stages of the initiative. Dr. Sullivan’s regional informants – Dr. Kim McGrail (Centre for Health Services and Policy Research, University of British Columbia), Dr. Bill Ghali (Institute for Public Health, University of Calgary), Dr. Steini Brown (Institute of Health Policy, Management and Evaluation, University of Toronto), Dr. Jean-Louis Denis (École nationale d'administration publique), Dr. Stephen Bornstein (Newfoundland and Labrador Centre of Applied Health Research) and Marcel Saulnier (Health Canada) – contributed much-appreciated regional expertise and insight. We would like to sincerely thank the members of our project advisory committee – comprising Kathryn Andrews-Clay (Canadian Institutes of Health Research), Krista Connell (Nova Scotia Health Research Foundation), Lee Fairclough (Canadian Partnership Against Cancer), Jan Hux (Canadian Diabetes Association), and John Riley (The Arthritis Society) – each of whom provided highly valued strategic guidance from the initiative’s conception through to the completion of this report. Finally, we would like to thank Chris Mercer and her team at AdHawk Communications Inc. for producing the asset maps that accompany this report. Without this rich collaboration of organizations and people, the pan-Canadian vision and strategy for health services and policy research would not be possible.

Table of Contents

• List of Tables
• List of Figures
• Message from the Leads
• 1. Executive Summary
• 2. Introduction and Project Background
• 3. Project Objective and Approach
• 4. Project Governance
• 5. Project Methodology
• 6. Overview of Findings
• 7. Findings and Recommendations
• References
• Appendix A: Asset Map Methodology
• Appendix B: Pan-Canadian Health Services and Policy Research Jurisdictional Tables
• Appendix C: Funding Data Overview
• Appendix D: Research Themes & Funding Type
• Appendix E: Universities with HSPR Training Centres

List of Tables

• Table 1: National funding overview by funder (2007/08-2011/12)
• Table 2: Total health services and policy research funding received by province and by source (2007/08-2011/12)
• Table 3: Health services and policy research per capita research investment analysis
• Table 4: Total health services and policy research funding received by province (2007/08-2011/12)
• Table 5: Total funding by funding type
• Table 6: Top funding organizations of salary awards
• Table 7: Top 10 institutions by health services and policy research funding received (2007/08-2011/12)
• Table 8: Top funded institutions in Ontario and Alberta
• Table 9: Total health services and policy research funding by research theme (2007/08-2011/12)
• Table 10: Health services and policy research organizations, projects and Nominated Principal Investigators (NPIs)
• Table 11: Top 3 funded institutions for each research theme
• Table 12: Top 5 Universities – All training awards
• Table 13: Top funding organizations for salary and training awards

List of Figures

• Figure 1: Canadian HSPR Maturity Curve
• Figure 2: Project Governance
• Figure 3: Outline of the methodology used to build asset map
• Figure 4: HSPR Strategic Analytic Framework
• Figure 5: Trend in total health services and policy research investment (2008/09-2011/12)

Message from the Leads

Canadians care about their health care system. Access, quality, affordability and good health remain top of mind goals for all Canadians who expect that the 200 billion in public and private spending that we invest in health care each year is invested wisely, in evidence-informed programs, services and technologies that improve system performance and health outcomes.

It is increasingly recognized that a high-performing health care system requires a high-performing HSPR enterprise, including a trained community of world-class researchers, accessible platforms and infrastructure to support innovative analyses, engaged knowledge users committed to evidence-informed policy- and decision-making, and sustainable funding programs.

Health services and policy research (HSPR) is the field of scientific investigation that aims to ensure our scarce resources are invested in programs, services and technologies that work. Indeed, HSPR focuses on improving the way health care services are organized, regulated, managed, financed, paid for, used and delivered. In simpler terms, HSPR produces knowledge of what works, for whom, at what cost, and under what circumstances in the interests of strengthening our health care system and improving the health and wellbeing of individuals and populations.

This inaugural report and the corresponding asset map from the CIHR Institute of Health Services and Policy Research (CIHR-IHSPR), provincial health research organizations from across the country, and a number of Canada’s Health Charities represents an important first step in our understanding of the HSPR enterprise in Canada and, more specifically, the HSPR funding landscape (Building the foundation for a pan-Canadian vision and strategy for Health Services and Policy Research). It shows that Canada funds and conducts a substantial and increasing amount of HSPR, that HSPR investments reflect the priorities that have dominated health care agendas over the past ten years, that HSPR capacity is clustered in certain regions across the country, and that greater investment may be needed in areas related to financing and sustainability, change management and scaling up innovation.

We intend to harness this understanding of Canada’s existing assets and resources to plan for the future success of our HSPR enterprise. The organizations involved in this report are committed to working together to develop a pan-Canadian vision and strategy for HSPR that will utilize partnerships and collaborations to optimize HSPR investments, strengthen the HSPR enterprise, and position Canada as a global leader in the evidence-informed improvement of health and health system outcomes.

This report was made possible because of the widespread and shared belief among a number of organizatison that HSPR matters and that there is value in collaborating to plan for a stronger future state. We would like to thank all of the organizations that contributed data to this inaugual exercise, including provincial health research funding organizations across the country and a number of health charities. In addition, we would like to thank the Canadian Cancer Research Alliance (CCRA) for paving the way with their Cancer Research Investment Surveys, on which our initiative was modelled. We would also like to thank Kim Badovinac at the CCRA for the valuable advice she shared with us based on her experience with the cancer research investment surveys. We would also like to acknowledge the Listening for Direction consultation exercise that was led by the Canadian Foudnation for Healthcare Improvement (then the Canadian Health Services Research Foundation) and CIHR-IHSPR in collaboration with other partners, which was Canada’s first national qualitative consultation on health services and policy issues and which informed HSPR funding investment, particularly at CIHR-IHSPR, for a number of years.

We are very grateful to the members of our project advisory committee for their ongoing strategic advice and guidance on all aspects of this initiative. Finally, we would like to give special thanks to Dr. Terry Sullivan and Melissa Heritage for their superb leadership of this inaugual exercise. It would not have been possible without them.

Robyn Tamblyn, PhD
is the Scientific Director of CIHR’s Institute of Health Services and Policy Research and a Professor in the Department of Medicine and the Department of Epidemiology and Biostatistics at McGill University.

Christina Weise, MPA
is the Executive Director of the Manitoba Health Research Council and Co-Chair of the National Alliance of Provincial Health Research Organizations.

Diane Finegood, PhD
is the President & CEO of the Michael Smith Foundation for Health Research in British Columbia and Co-Chair of the National Alliance of Provincial Health Research Organizations.

Deirdre Freiheit
is the Executive Director of the Health Charities Coalition of Canada.

1. Executive Summary

Canadian health services and policy research (HSPR) represents a diverse and growing field. Concerns about the quality, cost and sustainability of the health care system are dominant across the majority of countries and Canada is no exception. The ability of HSPR to inform and evaluate what works, for whom, at what cost, and under what circumstances makes a direct contribution to strengthening our health care system and thus improving the health of Canadians. As the field of HSPR evolves, so too does the desire to qualify and quantify its growth and evolution and to harness such information to plan for its future success.

This report marks the first concerted effort on behalf of a wide range of health policy and services research funders to document and understand the current state of HSPR investment in Canada, and what this investment has created in terms of assets, resources, strengths, opportunities and gaps upon which to build moving forward. This report outlines the process of over 19 partner organizations working together over a period of six months to define, collect, validate and analyze HSPR investment data to understand the current state of assets, resources and activity within Canada’s HSPR enterprise. The data in this report show that Canada funds and conducts a substantial and increasing amount of HSPR. Over 200 organizations are identified as participating in the funding, conducting, educating, use and support of HSPR in Canada. The top funded themes of research to date reflect the priorities that have dominated health care agendas over the past 10 years, including “managing for quality and safety”, “linking population and public health with health services”, “primary and community based healthcare” and “patient-centered care”, with “access to appropriate care across the continuum” as the top-funded theme nationally and within the top three funded themes in all provinces and territories included in this analysis. It is of note that these priority research themes are different from those in a comparable European study of health services research, where Policy Reform, Administration/Management, and Professional Education Ranked top three in total activity.¹

The data show that while HSPR activity occurs across the country, it clusters in the three largest provinces and their greater metropolitan regions (Vancouver, Toronto and Montreal), both in terms of funding received, and number of projects, organizations and researchers involved in HSPR. The percentage of provincial research investments versus other source funding (e.g., from federal and other sources) varies across provinces, with more competitive (provincially leveraged) jurisdictions appearing to include British Columbia, Alberta, Ontario and Nova Scotia. Overall, this report and the corresponding asset map (to be found on CHIR-IHSPR web site in January 2014) provide an important picture of the maturation of the HSPR community and serve as a key foundation for strategic planning.

As with most inaugural efforts, there is much to learn and improve upon moving forward. The Canadian Institutes of Health Research’s Institute of Health Services and Policy Research (IHSPR) and its partners in the National Alliance of Provincial Health Research Organizations and the Health Charities Coalition may choose to continue to this exercise using a survey approach every three to five years, and they may wish to expand upon the number and types of organizations included. The process to build the present analysis is based on the one started approximately eight years ago by the Canadian Cancer Research Alliance, which now includes over 40 participants in its annual survey up from an initial 19 participants in 2005.² Working with a panel of representatives from partner organizations and a dedicated resource, the present report and corresponding asset map and related findings will be used to inform a pan-Canadian vision and strategy for HSPR that positions Canada as a global leader and optimizes health and health system outcomes. It is intended to serve as an evidence-informed input to support research and policy priority-setting and may shorten the know-do gap over time.

2. Introduction and Project Background

The past ten years have been an important maturation period for health services and policy research in Canada. Figure 1 illustrates the emergence of health services and policy research and its trajectory leading up to the present. The origins stem from the National Health Research and Development Program within Health Canada, the emergence of the Canadian Health Services Research Foundation (now Canadian Foundation for Health Care Improvement) and the emergence of the Canadian Institutes of Health Research (CIHR) and the Institute for Health Services and Policy Research (IHSPR) in 2000.

Figure 1: Canadian Health Services and Policy Research Maturity Curve

Figure 1 long description

Partnership has been a key feature of the development of this field of research in Canada and is marked by a number of important programs such as the Capacity for Applied Developmental Research and Evaluation in Health Services and Nursing Program (CADRE), the Drug Safety and Effectiveness Network (DSEN) in partnership with Health Canada, Evidence on Tap and Best Brains Exchanges in partnership with ministries of health across the country, and Partnerships for Health System Improvement. The pan-Canadian vision and strategy for health services and policy research reflects the desire to continue this collaboration and chart the course for the next decade. This report outlines the goals and objectives of this project, along with a series of key findings and recommendations that can be used to support defining the vision and priorities in the decade ahead.

3. Project Objective and Approach

The Canadian Institutes of Health Research’s Institute of Health Services and Policy Research (IHSPR) aims to position Canada as a global leader in optimizing the health and health outcomes in the population through the provision of evidence-informed healthcare services. IHSPR, the provincial health research funding organizations, and many of Canada’s health charities are working together to develop a pan-Canadian vision and strategy for health services and policy research (HSPR). This approach reflects the shared belief that the challenges facing our health care system are best addressed through a common vision and collaborative approach to supporting HSPR. This vision and strategy will serve as a cornerstone for the development of Canada’s HSPR agenda for the next 10 years.

The development of the pan-Canadian vision and strategy for HSPR comprises three phases:

• Phase 1: Development of a strategic planning platform (an asset map of Canadian HSPR and compendium report on HSPR funding in Canada), informed through the identification of the current magnitude and distribution of assets and resources (including research investments) across the country.
• Phase 2: Assessment of the major strengths, challenges and opportunities for HSPR in Canada through compilation and analysis of Phase 1 data.
• Phase 3: Definition of pan-Canadian vision, strategy and shared priorities for HSPR - defined by IHSPR, its partners and stakeholders, and the HSPR community - and informed by Phases 1 and 2.

This report summarizes the process and findings of Phase 1 of the project, which aimed to describe the state of HSPR funding, assets and resources in Canada using a standardized and collaborative approach. It represents the first initiative of its kind on the part of HSPR funders across the country. The information contained in this report and the corresponding asset map provide a baseline measure of the nature and quantity of HSPR investment made in Canada over a five-year period from 2007/08 to 2011/12, and will be used for a joint strategic planning exercise that culminates in pan-Canadian vision and strategy for the future success of HSPR. IHSPR is committed to continuing and expanding data collection for the next version of this report.

How is Health Services and Policy Research Defined?

For purposes of this project, HSPR is defined as:

Health services research is a multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviours affect access to health care, the quality and cost of health care, and, ultimately, Canadians' health and well-being.³

What’s in this Report?

This report contains information on the project governance and methodology as well as who is funding HSPR in Canada, the magnitude and type of HSPR investment, and areas of science being supported. The report is organized around four major themes:

• Fund: Who is funding, how much, with what funding mechanisms, and in what areas of science?
• Conduct: Which provinces and institutions are conducting HSPR and in what areas of science?
• Educate: What is the magnitude and distribution of salary and training awards?
• Support: What are the major platforms and infrastructures that support HSPR

Report Scope

While a number of major HSPR funders from the governmental (federal and provincial) and voluntary sectors are included, this report does not include all funders of HSPR in Canada. It focuses on research that was peer-reviewed at the time of application or publication and from organizations that fund HSPR in excess of $100,000 annually. While all provincial health research funding organizations are included in the report, not all Health Charities participated. A number of provincial ministries of health invest in HSPR and these investments are not included at this point in time (with the exception of the Ontario Ministry of Health and Long-term Care, which is unique as it is also a member of NAPHRO). Similarly, at the federal level, Health Canada, the Public Health Agency of Canada, and Genome Canada are not included. HSPR investments made by Think Tanks and private sector firms were deemed outside the scope of this report and are therefore not included.

4. Project Governance

The project has been guided by a Project Advisory Committee comprising members of CIHR, NAPHRO, the Health Charities Coalition and IHSPR’s Institute Advisory Board. The core project team worked in collaboration with a group of regional informants to plan and execute Phase 1. Regional informants worked along with data validators to ensure high-quality data and analysis. Details of this team and structure are included in Figure 2.

Figure 2: Project Governance

Project Steering Committee

CIHR-IHSPR

Core Project Team

• Project Lead: Terry Sullivan
• Research Lead: Lillian Bayne
• Project Manager/ Analyst: Melissa Heritage
• Data Lead: Laura Purves
• Research Analysts: Mark Dobrow & Sandra Hoffsteter
• GIS Support & Survey: AJ Hirsch-Allen, Ofer Amram

Regional Informants

• Kim McGrail – Assistant Professor, School of Population and Public Health, UBC - BC
• Bill Ghali – Director, Calgary Institute for Public Health, University of Calgary – AB, SK, MB
• Steini Brown – Director, Institute of Health Policy, Management & Evaluation, University of Toronto - ON
• Jean-Louis Denis – Professor, ENAP - QC
• Stephen Bornstein – Director, Centre for Applied Health Research, MUN - Atlantic
• Marcel Saulnier – Director General, Health Canada - Pan-Canadian

Project Advisory Committee

• Krista Connell , CEO Nova Scotia Health Research Foundation
• John Riley, Vice President, Research, Arthritis Society
• Jan Hux, Chief Scientific Advisor, Canadian Diabetes Association
• Lee Fairclough, Vice President, Strategy, Knowledge Management & Delivery, Canadian Partnership Against Cancer
• Kathryn Andrews-Clay, Director, Institute Affairs, CIHR

Figure 2. This figure illustrates the governance structure of the initiative, including the project steering committee, core project team, regional informants and project advisory committee.

The framework for the Phase 1 deliverable was vetted during the May 2013 Canadian Association for Health Services and Policy Research conference by the Network of Centre Directors and a small focus group of leaders in the field. These groups provided important feedback on the process and reinforced the value of using an asset map as a foundation for strategic planning rather than a stand-alone artefact.

5. Project Methodology

This is the first time that HSPR funding data from multiple organizations and jurisdictions have been collected, analyzed and jointly reported in Canada. The results are both interesting and informative and lay a strong foundation for a collaborative approach to strategic planning. Critical to the development of this report and corresponding asset map was the input of the Project Advisory Committee as well as key regional informants who informed and validated the data collection and organizational analysis activity.

Data Collection and Participating Organizations

For purposes of this project, research activity is defined as activity subject to peer review at point of application and/or publication. Data were collected from public and not-for-profit organizations that fund research that meets this definition and who fund in excess of $100,000 annually in HSPR. Data were not obtained from private industry sources or federal or provincial departments of health.

The data contained in this report cover a five-year period from 2007/08 to 2011/12. Any project that had a funding start date within this time period was included. Data were collected through the development of a standardized template of core data elements that was reviewed and approved by all partner organizations prior to use. Among the data requested of each project were: name of nominated principal applicant and all other principal and co-applicants; research institution of the nominated principal applicant; project title; project abstract; project start and end date; project funding amount (total and by year); and project keywords.

Data were collected between June and September 2013 from the following 27 organizations:

1. CIHR
2. Canada Foundation for Innovation (web source)
3. Canada Research Chairs (web source)
4. Networks of Centres of Excellence of Canada (web source)
5. Canadian Foundation for Healthcare Improvement
6. Alberta Innovates - Health Solutions
7. Fonds de recherche du Québec - Santé
8. Manitoba Health Research Council
9. Michael Smith Foundation for Health Research
10. New Brunswick Health Research Foundation
11. Newfoundland and Labrador Centre for Applied Health Research
12. Nova Scotia Health Research Foundation
13. Ontario Ministry of Health and Long-Term Care
14. Saskatchewan Health Research Foundation
15. Heart & Stroke Foundation of Canada
16. Canadian Diabetes Association
17. Cystic Fibrosis Canada
18. Canadian Cancer Society
19. Alberta Cancer Foundation
20. Canadian Breast Cancer Foundation
21. Canadian Breast Cancer Research Alliance
22. Cancer Care Ontario
23. Ontario Institute for Cancer Research
24. Pediatric Oncology Group of Ontario
25. Alzheimer Society of Canada
26. Parkinson Society Canada
27. The Arthritis Society

Project Classification

All projects were validated to ensure relevance to health services and policy research. Relevant projects were classified according to the type of funding mechanism (e.g., operating grant, team grant, network grant, salary award, trainee award, infrastructure grant) and research domain area. Fourteen research theme areas were used. Theme areas were identified based on those that persisted throughout all three Listening for Direction⁴ exercises (it was determined that theme areas that were identified in the 2001, 2004 and 2007 iterations of Listening for Direction – a national consultation on health services and policy issues that commenced in 2001 and ended in 2007 - were a reasonable basis for classifying investment over the period of the present report) and IHSPR’s priority research areas. An additional category called “Centre, network and infrastructure-related” was used to capture funds that flowed to large data centres and networks/centres lacking a domain focus. This category also included travel and journalism awards that could not be assigned to domain-related categories.

1. Primary and Community-Based Healthcare
2. Access to Appropriate Care across the Continuum
3. Governance and Accountability
4. Health Information (e-health)
5. Drug Policy
6. Health Care Financing and Funding/Health Economics
7. Managing for Quality and Safety
8. Change Management/Scaling up Innovation
9. Health Human Resources
10. Patient-Centered Care
11. Emerging Technology and Drugs (technology assessment)
12. Linking Population and Public Health with Health Services
13. Knowledge Translation/ Implementation Science
14. Health Information: Use of Administrative Databases
15. Centre, network and infrastructure-related

Other Organizations involved in Health Services and Policy Research

In addition to data collection from HSPR funders, an environmental scan was conducted of other key organizations in the HSPR community who are engaged in one or more of the following activities: funding research, conducting research, using research, educating or providing infrastructure and/or data support.

Analytic Strategy

Figure 3 outlines the analytic approach used to build the asset map and analyze the data. Table 1 provides the details of each step. Overall, the following analyses were conducted:

• Total HSPR funding in Canada and by province, including source of funding
• Total HSPR funding by research theme in Canada and by province
• Funding of salary and training awards in Canada and by province
• Knowledge translation activity, both provincially and by host institution
• Top-funded host institutions
• Number of researchers (Nominated Principal Investigators) by province and host institution

Figure 3: Outline of the methodology used to build asset map

Figure 3 long description

Data Quality

A number of steps were taken to strive for the best data quality possible. The data collection template was developed and finalized in collaboration with all partner organizations to ensure common understanding of all requested data fields. A data collection guide was developed and shared with all partner organizations along with the template, which included a short project overview, a definition of HSPR, the inclusion criteria (e.g., project was self-identified as Pillar III / Health Services and Policy, project was reviewed by a Pillar III / Health Services and Policy peer review committee), and definitions of each data field.

Data completeness varied across partner organizations but on the whole, most organizations had complete data (i.e., for each requested data field). In some cases, project abstracts or keywords were not available or a project’s total but not annual funding was available. Data from four partner organizations were not available for the full time period. This is noted in all relevant analyses. Finally, for the majority of organizations, including CIHR, projects were identified using self-identified Pillar III / Health Services and Policy affiliation, which applicants select at the time of grant application. It is recognized that this method results in some miss-classification (in both directions – false positives and false negatives are possible) but for the initiative’s inaugural exercise it was preferred from a timeliness and feasibility perspective.

Once data were submitted from all partner organizations, projects were reviewed for relevance to HSPR and any that were questionable or clearly not relevant (e.g., a biomedical project) were discussed with the project team and then shared with IHSPR for review. A total of 292 projects were excluded as non-relevant to HSPR.

The finalized database of all relevant HSPR projects and list of all organizations participating in HSPR was used to compile summary statistics at the national and provincial level and shared with Regional and other informants (e.g., individuals familiar with the HSPR landscape in their respective province) in each jurisdiction as a validation step. Validators were asked four consistent questions to help ensure accuracy and completeness of the data. This step helped to uncover a number of “hidden assets” in HSPR in Canada.

This methodology reflects best efforts to triangulate knowable health services and policy research funding data and organizations. It is expected that it may evolve over time as additional learnings are gathered through review and use of the data. The experience of developing this analysis also provides important insights into how future data collection and analysis may occur to maintain and sustain the picture of health services and policy research activity in Canada.

6. Overview of Findings

Key findings from the analysis of the magnitude and nature of HSPR funding and of the environmental scan of key HSPR organizations in Canada are presented below. The HSPR funding data allows for analysis of who is funding what (e.g., funding vehicle and domain area) and whom, and to which province and host institution the funds flow. Findings are presented according to the analytic framework presented in Figure 4, which captures the primary functions of HSPR: funding research, conducting research, using research to inform or support decision making, policy or practice, education of researchers and infrastructure and data support.

Figure 4: HSPR Strategic Analytic Framework

Fund: Provide financial support for conducting health services and policy research. Includes the amounts and associated funding vehicles.

Conduct: Conduct health services and policy research activity. Includes the organizations, researchers, projects and themes.

Use: Review and analyze research that has already been produced to determine conclusions and applications. Point where research knowledge is translated into practice in some way.

Educate: Provide core skills, methods and key learnings for health services and policy researchers to build capacity and excellence.

Support: Collect, store and share data for the purpose or in support of health services and policy research. Development of specific infrastructure to enable health services and policy research activity and/or advancement.

Figure 4. This figure depicts the strategic analytic framework that was used as the foundation for the analysis. The framework includes five categories that represent the core functions of the health services and policy research enterprise: fund research; conduct research; use research; educate (i.e., train and build capacity); and support research.

Fund: 1. Health Services and Policy Research: Funding

Total Health Services and Policy Research Investment across Canada

Overall, nearly $770M was invested in HSPR between April 2007 and March 2012 (Table 1) representing important growth in this field. This figure comes from the investments of the 27 organizations that were part of this inaugural exercise and is likely an under-representation of Canada’s total HSPR given that there are other organizations funding HSPR that are not represented in this report. It is comforting to see a strong presence and proliferation of funding organizations. While annual data was not available from all organizations, Figure 5 shows that HSPR investment is increasing over time. Research funded by CIHR, Ontario’s Ministry of Health & Long Term Care (MOHLTC), and Fonds de recherche du Québec – Santé (FRQS) represented the largest share of total HSPR investment (85%).

Figure 5: Trend in total health services and policy research investment (2008/09-2011/12)

Figure 5 long description

Provincial investment in HSPR varies across the country and it appears that some provinces leverage their investments to attract additional sources of funding (e.g., from CIHR and other funders) to greater extent than others (Table 2). For example, for every dollar that British Columbia invests in HSPR, it attracts an additional $6.66 from other sources (a six-fold leverage). For every dollar that Alberta invests, it attracts an additional $2.95 (an almost three-fold leverage). Other provinces, including Saskatchewan, Manitoba, Quebec and New Brunswick, rely more heavily on their provincial sources of funding than other sources.

The total amount that provinces invest in HSPR varies across the country, as illustrated in Table 2. Not surprisingly, Ontario, Quebec, British Columbia and Alberta capture the lion share of funding in Canada, as they also have the largest populations in the country. However, provincial investment in HSPR was also analyzed on a per capita basis (Table 3) and it is seen that the leading per capita investors (from provincial sources of funding) include Ontario, Quebec, Saskatchewan, Manitoba and Nova Scotia. Table 4 shows the amount of funding received in each jurisdiction.

Funding Mechanisms

HSPR investments are made through a variety of different funding mechanisms, such as operating grants, team grants, networks and centres, salary/career awards, training awards, and others. Table 5 lists the categories of funding mechanisms used in this analysis and the total HSPR investment and percentage of total investment each received. Two funding mechanisms account for over half the funding distributed in Canada. The top funding mechanism is operating /project/program research grants, which comprises 35% of total funding. Over half of that funding comes from CIHR. The source of the second highest funding mechanism - centre and network funding at 21% of total funding - is provincial, with the largest investment coming from the MOHLTC and FRQS. The remaining funding mechanisms each receive less than 7% of total funding. CIHR funding represents a significant share (approximately 90%) of total investment in certain funding mechanisms, including capacity and training grants, meeting and planning-related grants, and knowledge translation research programs. Health Charity organizations account for 90% of equipment and infrastructure grants and FRQS funds one-quarter of the total salary awards distributed in Canada (Table 6).

*Cancer Organizations include: Alberta Cancer Foundation, Canadian Breast Cancer Foundation, Canadian Breast Cancer Research Alliance, Canadian Cancer Society, Cancer Care Ontario, Pediatric Oncology Group of Ontario, Ontario Institute of Cancer Research

**Provincial Agencies include: BC Ministry of Health, Manitoba Health

***Health Charities include: Cystic Fibrosis Canada, The Arthritis Society, Alzheimer Society of Canada, Canadian Diabetes Association, Parkinson Society Canada

Conduct: 2. Health Services and Policy Research: Research Activity Analysis

Research is conducted across the country with significant pockets of capacity in the more populous regions. Based on the data analysis and the environmental scan of other organizations engaged in HSPR in Canada (i.e., in relation to the five core functions of fund, conduct, use, educate, support), there are 225 organizations active in Canada’s HSPR enterprise (Appendix B). Over the five-year period of this exercise, the data analysis reveals that a total of $770 million was invested in HSPR across 3207 projects. Details of the breakdown by province are depicted in Table 10.

Health Services and Policy Research Activity at the Institution Level

The institutions that attracted the greatest share of total HSPR investment between 2007/08 and 2011/12 are listed in Table 7. Seven of the top 10 institutions are located in Ontario, with the other three based in British Columbia, Alberta and Quebec. British Columba attracted 9% of total HSPR funding (provincial plus other/external sources of funding) in Canada (Table 4) and the University of British Columbia (UBC) is Canada’s top-ranked institution for receiving funds (Table 7).

In terms of within-province distribution of HSPR funding across institutions, Ontario and Quebec have a relatively even distribution of funds among their many institutions. The top eight funding recipient institutions in Ontario, with funding of more than $20M per institution, each represent 5% to 10% of Ontario’s total funding. This differs greatly from most other provinces, where one or two institutions represent the majority of HSPR funding. For example 87% of funding in Alberta goes to either the University of Alberta or the University of Calgary (Table 8). It should be noted, however, that the manner in which host institutions receive and disclose funding is a function of the arrangement between provincial governments and their academic health sciences centres and universities. In particular, this arrangement determines whether academic health sciences centres hold the funding dollars or whether the university or health region holds the funding dollars.

Investment in Health Services and Policy Research Theme Areas

The top funded HSPR themes over the period of analysis reflect the priorities that have dominated health care agendas over the past 10 years with “access to appropriate care across the continuum” as the top-funded theme nationally (Table 9) and one that appears in the top three research themes in all jurisdictions. The top funded five themes are (% of total share):

• Access to Appropriate Care across the Continuum (14.4%)
• Managing for Quality and Safety (11.9%)
• Linking Population and Public Health with Health Services (9.4%)
• Primary and Community-Based Healthcare (8.8%)
• Patient-Centred Care (7.3%)

The bottom funded three themes are:

• Health care financing and funding (1.6%)
• Emerging technologies and drugs (technology assessment) (0.5%)
• Change management / scaling up innovation (0.3%)

Total investment in each research theme is presented in Table 9. Information on the top funded institutions within each research theme is available in Table 11. As seen in Table 11, two research theme areas are dominated by a single host institution. The University of British Columbia accounts for 40% of total drug policy funding in Canada. The University of Waterloo accounts for 33% of linking population and public health with health services funding in Canada, due to the significant funding provided to the Propel Centre for Population Health Impact, which is based at the university.

Other Health Services and Policy Research Activity

Canada’s HSPR enterprise depends not only on sustainable investment in research (and the training of these researchers), but also on the production of research evidence, the use and application of such evidence to improve health and health care, and the availability of platforms and data that provide the foundation. In an effort to capture the rich and diverse array of organizations that contribute to this enterprise above and beyond the funders of HSPR, an environmental scan of organizations involved in the conduct, use, education and/or support of HSPR was also conducted. A total of 225 organizations were identified. An enumeration of these organizations and their alignment with five key functions are listed in Appendix B. Table 10 below summarizes organizations by jurisdiction at a high level.

Educate: 3. Health Services and Policy Research: Educate

Growth of the field of HSPR is a combination of demand and supply and perhaps innovation. The availability of training, mentoring and educational opportunities for health services and policy researchers is key to building capacity in this field (as in other fields) and has been a primary focus over the past 10 years with major initiatives such as the Capacity for Applied and Developmental Research and Evaluation in Health Services and Nursing (the “CADRE” program), led in partnership by the Canadian Foundation for Healthcare Improvement (formerly called the Canadian Health Services Research Foundation) and CIHR, the Strategic Training Initiative in Health Research Grants (the “STIHRs”) led by CIHR, and the establishment of the Canadian Association of Health Services and Policy Researchers (CAHPSR) and the increasing participation of students within it. There are over 20 universities (see Appendix E) across the country with an explicit training program in HSPR and significant investment has been made in salary/career and training awards, which provide a dedicated source of support for researchers to develop their programs of research.

Trainee Support in HSPR

Investment in HSPR training awards was categorized into three funding mechanisms: masters awards, doctoral awards, and fellowships. Overall, investment in training awards accounted for 5.7% of total HSPR funding in Canada. Masters awards received 0.8% of total HSPR investment ($5.8M), doctoral awards received 2.3% ($17.7M), and fellowships 2.1% ($16.2M). Table 5 shows the breakdown of investment across all funding mechanisms (e.g., salary awards, operating grants). Not reflected in these data is the training support provided through team grants and other funding mechanisms that tend to have training and capacity building requirements built into their core objectives.

Table 12 illustrates the top funded institutions by all training awards. The University of Toronto and University of British Columbia attracted the largest investment in training awards, and the funding sources are listed in Table 13. Although Dalhousie ranks 12th overall in universities receiving total funding, it ranks 4th overall in recipients of training awards (Table 12). Over two-thirds of training funding received by Dalhousie is funded by the Nova Scotia Health Research Foundation. CIHR funds a significant portion of training awards to the University of Toronto (85%) and University of British Columbia (74%).

Salary Support in HSPR

Investment has also been made to support investigators across the full continuum of the career trajectory. Overall, investment in salary/career awards accounted for 11.1% of total HSPR funding in Canada. New investigator-type awards received 1.4% ($10.9M) of total HSPR investment, mid-career-type awards received 2.1% ($16M) of total HSPR investment, and clinician scientist awards received 1.6% ($12.2M). FRQS is a generous supporter of both training awards and salary awards (Table 13). Details of top funding organizations are listed below.

Support: 4. Health Services and Policy Research: Support

Data is the lifeblood of research and is a critical enabler. The data platforms are enumerated as a support function in Appendix B. A number of other CIHR centres for research development were added between 2002 and 2010. These are constructed for specific topical areas of population health and are associated with the Institute for Population and Public Health.⁵

Canada has traditionally been known for its wealth of data as a publicly funded system with access to large administrative data sets. However, only a few provinces have established, well-functioning data centres to support HSPR, although several other provinces have capacity that has not yet been fully stimulated or exploited. These established data centers include the Institute for Clinical Evaluative Sciences in Ontario, the Manitoba Centre for Health Policy in Manitoba, the UBC Centre for Health Services and Policy Research and Population Data BC in British Columbia. A number of other provinces have growing data sources for HSPR including Alberta, Saskatchewan, Nova Scotia and Quebec. Both the Canadian Institute for Health Information and Statistics Canada (including the Research Data Centre initiative) are important assets at the national level for health data. In addition, a number of organizations work actively to support this community. The role of IHSPR and CAHSPR are noted leaders in building and advocating for this community. A number of other CIHR centres for research development were added between 2002 and 2010 associated with the CIHR Institute of Population and Public Health.

7. Findings and Recommendations

This report provides a portrait of the magnitude, nature and diversity of HSPR funding investment, assets and resources in Canada over a five-year time period. It reflects the first joint effort of a group of organizations that fund HSPR and who share a belief that the future success of health care in Canada will be informed by HSPR. Given the many funders and diversity of researchers and host organizations, it has become apparent that a nimble, pan-Canadian planning effort is an essential ingredient to appropriately set priorities, align partnership opportunities for funds, and to create some form of allied structure to advance HSPR in this country. Such planning is likely to more effectively serve the policy and decision makers in health services, patients, providers and the researcher community by allowing for greater coordination in focus and leverage for health services research and health care reform.

Key Findings

Funding:

1. Canada has spent over $770 million on HSPR from all sources between 2007/08 and 2011/12. The CIHR is the leading funder of HSPR in Canada, as befits its status as our national health research agency. But national agencies, provincial agencies and their governments and charitable organizations are all important contributors. The numbers presented in this report are a conservative assessment of Canada’s investments in HSPR, as they do not include all organizations. For example, research investments made by ministries of health (with the exception of the Ontario Ministry of Health and Long-term Care, which is unique as it is also a member of NAPHRO), Health Canada, the Public Health Agency of Canada, and Genome Canada are not included, and not all Health Charities participated. Similarly, any investments from private-sector organizations are not included, nor are the occupational health and safety research programs delivered in association with workers compensation boards in Canada, particularly Quebec, Ontario and British Columbia. However, the workers compensation research number constitutes .001% of all public spending on health care during the 2007/8-2011/12 period.
2. Spending is growing and comes from a diversified source of agencies, governments and charitable organizations. Moreover it is captured and received by a range of institutions, consistent with the unique institutional structures in place in each province and at the national level.
3. There is no right number identified for what should be spent, or from which sources, as decision makers have a growing desire for better evidence and evaluation, better tools, and more rapid application of new tools and evidence to service and policy reform. It is a logical extension that HSPR should continue to grow and evolve consistent with the value proposition presented by the scientific community to the policy and clinical and administrative decision-making communities. This point is taken up in recommendations that follow.
4. As with all comparisons in Canada, there are significant differences between jurisdictions, differences in proportionate investment by provinces and differences in the competitive capacity to succeed in national and international competitions for funds. Total per capita investment from all sources ranges from a low of $1.12 in PEI to a mid-range of $14.98 in Alberta to a high of $30.13 in Ontario. With respect to provincial only sources of investment Manitoba, Nova Scotia and Quebec stand out for their generous provincial support and Quebec and Nova Scotia for personnel support in particular. Viewing provincial sources as a leverage point for effective national and international competition, British Columbia (7 fold leverage) and Alberta (almost 4 fold leverage) would appear to be successful at leveraging their provincial spending to attract national and international funds. Quebec doubles and Ontario triples their respective provincial HSPR investments.
5. The per capita figures warrant particular attention as both the UK and the US have tried to move towards targeted commitments to overall health research spending (UK) and health services research warrants special scrutiny to maintain reform momentum. The US Congress specified in 1989 that one-half of 1 percent of the National Research Service Awards (NRSA) budget for training be allocated for training HSPR researchers through the Agency for Health Care Research & Quality. They subsequently expanded that allocation to 1 percent of NRSA funding in 1999, which has remained unchanged.⁶ In the UK, Tony Culyer in 1994 provided a landmark series of recommendations on overall health research including a 1.5% of NHS spending target on the funding of all health research. Both of these strategies have merit and might be worthy of consideration for a Canadian reflection on the spending related to health services research. While there is no simple compilation on health services research in either of our sister nations which quite matches the current Canadian effort, it may be worthy of trying to mount some closer apples to apples comparisons with the national research agencies in both countries. The most recent estimates cited from Kieran Walshe and Huw Davies in 2013 suggest about 7.5% of total health research spending is directed towards HSPR in the UK.⁷ This begs the musical question of the merit for setting a target for HSPR as a function of either a) all health research spending or b) as a fraction of overall public spending within this country.

Priority Focus:

1. It is apparent that the priority funding streams for HSPR have been well taken on by HSPR researchers in Canada at the project, program and personnel support level. The top ranked priorities in order of investment include Access to Appropriate Care, Managing for Quality and Safety, Linking Population and Public Health with Health Services, Primary and Community-Based Healthcare and Patient Centered Care. At the lower end were Healthcare Financing and Funding, Health Technology Assessment, as well as Change Management/Scaling up innovation - all areas which would seem to be central to reform efforts to achieve the Canadian equivalent of the Triple Aim (see Table 9 for priority investment listing). In consideration of the next stage of planning for the pan-Canadian vision and strategy it may be worthwhile to examine current priorities for decision makers to ensure the programs of today are meeting the challenges of tomorrow. The know-do gap in clinical practice is no less of a know-do gap in HSPR with respect to decision making in health services management and policy.

Comparative Performance:

1. Among the key issues raised in key informant interviews with HSPR leaders was how little comparative performance data are produced between jurisdictions in Canada. CIHI does an excellent job of presenting descriptive information on administrative data, as does OECD among its member countries, however there is little HSPR work that compares a range of quality and performance benchmarks among Canada’s provincial-territorial health systems. This appears to arise in part but not exclusively because of privacy barriers. Real or perceived barriers to link data across provinces must be overcome by active leadership from the research community. Of course another reason for this is that there appears to be little appetite by provincial governments for the evaluation of large policy initiatives. One thoughtful idea arising from the key informant interviews was to create a Canadian Observatory on health systems, which could undertake such comparative work with relative independence.

Recommendations

Recommendation 1: Continue to monitor and report HSPR activity

Building a portrait of the current state of HSPR in Canada is important not only because it yields a view of the activity today across a variety of dimensions, but because it also provides some illumination into how to sustain this activity going forward. One of the biggest challenges in creating an asset map of this kind lies in the consistency of the data and the clarity of the data elements. Given that this data has not been collected and integrated across all funders before, there are inconsistencies in data capture and the definitions of each element. Working with a group of representatives from partner organizations, IHSPR may take the lead to refine the template, and/or develop a data classification, collection and reporting cycle similar to that currently used by the CCRA using a biennial survey, quinquennial or to be determined cycle to maintain this view of activity. As part of this purification, through utilization effort going forward, a more rigorous and specific method to codify and classify the data according to research theme should also be considered. The participating organizations may wish to emulate the CCRA approach and assign a dedicated analytic resource (person) to support this process of partner engagement, data definition, collection, preparation, analysis and reporting. The effort to gather and “standardize” such diverse data sets will require dedicated resources and institutional commitment from CIHR and partner organizations.

Recommendation 2: Complement investment/activity analysis with impact measurement and reporting for HSPR

One of most frequent comments from key informants arising from any question of how much money is spent is that an ROI measure that goes beyond conventional academic/scientific citation impact measures is critically needed. The development of such measures could be pursued in conjunction with other organizations or as a small competitive research project on its own merit. Certainly the impact of research is a long chain with multiple links but developing some triangulated measures of impact would be very valuable in codifying the benefits of HSPR investments as well as bolstering the case for deeper commitments. Implementation science and operations research begin with the view that putting research into practice and closing the know-do gap are essential parts of the aspiration of most health services researchers. This can create discomfort when the implication is a bold change in the way we finance services or pay professionals, but finding the right impact assessments will inform how to better ensure the translation of HSPR into better services to patients and better policies for citizens. While all HSPR is contextually bound to local policy and institutional arrangements, international collaboration with like-minded HSPR organizations might help to create common instruments for impact assessment as well as common nomenclature for HSPR classification.

Recommendation 3: Maximize HSPR opportunities presented through SPOR

CIHR’s Strategy for Patient-Oriented Research (SPOR) has been in development over the last couple of years and is moving from gestation to delivery. Partnerships are emerging at the national and provincial level and infrastructure investment in SUPPORT Units across the country are intended to address the needs of patients, support decision makers and investigators in designing and conducting studies, and facilitate access to data (including linked datasets and the integration of emerging datasets). Given the significant resources associated with SPOR and the strength of the HSPR community in responding to health service and policy maker needs, SPOR presents a unique opportunity to build stronger provincial and regional infrastructure for HSPR, as well as administrative and policy reform.

Recommendation 4: Increase opportunities for embedded researchers

It is clear that one of the achievements in the last decade in HSPR has been to grow the cadre of talent in HSPR through regional training programs and national and provincial support for researchers. One of the principal issues faced by health service organizations and public agencies is to advance change based on best evidence from HSPR and with sensitivity to local context. In the last few years we have witnessed the emergence of growth in the number of HSPR researchers working in large public agencies, regional authorities and delivery system institutions.⁸ Embedded researchers focus on helping these organizations with research, analysis and sometimes implementation of change studies and evaluation of change studies. While these relationships are unique and require attention and cultivation, the opportunities to build capacity in health sector transformation and applied implementation science – not to mention entirely new career tracks for HSPR investigators – remain large and promising.

Recommendation 5: Define pan-Canadian priorities and joint funding and investment opportunities with other research funders: Create an HSPR Alliance among major funders

It is recommended that CIHR-IHSPR take a lead role in brokering a partnership alliance among the many organizations funding HSPR in Canada. The multiple organizations making documented investments in HSPR have common cause and purpose together. Moreover, they can more rapidly accelerate new work and leverage impacts by aligning and working together where there is common priority and common funding opportunities. CIHR-IHSPR may be the convener to build such an alliance and to support the continued documentation of HSPR across the country, with the spirit and intent of maximizing our collective HSPR assets and impact.

Recommendation 6: Explore ‘Big Data’ Opportunities

The new world of big science and ‘big data’ (linking of large and diverse data sets) offers many commercial possibilities. When the delivery system is built on the backbone of a single payer model of health service finance, the opportunities for Canada to build analytics around the linkage of purpose built databases and administrative data for purposes of discovery and application looms very large around us. In December 2013 a Tri-council effort in Canada is exploring the best way to move a research agenda forward tailored to our specific competitive advantages for big data (Tri-Council Consultations).⁹ Many discoveries on how best to advance the personalized medicine agenda for optimal care of patients, as well as the possibility to better inform health service organization, financing and delivery turn on the capacity to link research and administrative data. Such work holds great promise and appeal for a country willing to get its act together on privacy and appropriate data linkage and sharing for research purposes. Already many of the former privacy barriers to appropriate linkage appear to have been surpassed by virtual technology¹⁰ but this reality may not yet have penetrated many of the corridors of privacy authorities. With high capture of many health encounters within Canada, the emergence of new research cohorts within the country allow for an unprecedented look at ‘big data’ linkage from molecular to population health within Canada.

Recommendation 7: Identify provincial/national collaborative tables for policy and service leaders to set priorities with researchers

There have historically been good interactions between the federal –provincial-territorial government tables and HSPR leaders within Canada despite the propensity for continuous turnover of senior officials. The advent of SPOR allows for the strengthening of provincial level inputs at the policy level, which is already well advanced in many provinces in Canada, but perhaps less well advanced nationally. Assuming we can advance an alliance for HSPR, there ought to be some way to seek representation and engage with FPT health deputies to align common research reform efforts with an emerging health policy and health services research strategy.

In Summary

This report summarizes for the first time a comprehensive picture of HSPR investments from public and charitable sources within Canada. This was done by analyzing investment levels and patterns in HSPR between 2007/8 and 2011/12. Funding was traced through CIHR, national partner organizations, health charities, provincial health research funding agencies, and a limited number of provincial ministries. These data were analyzed according to the strategic analytic framework introduced in this report (via funding, conducting research, using research, educating researchers and decision makers, or supporting through infrastructure development) and mapped according to 15 different research themes. The analyses presented in this report have been adapted to an easy-to-use web-based tool – the asset map - that allows for rapid scanning of investment levels across the country, top priority areas receiving funding, and more. It is hoped this asset mapping - taken together with a wide ranging survey of the field and key thought leaders - can usefully inform not only the current status assessment, but illuminate the way forward among partners in HSPR towards a new, pan-Canadian vision and collaborative strategy for HSPR. The possibility of a stronger alliance among HSPR funders represents a potential breakthrough model to expand the value, volume and talent in HSPR research in this country.

References

1. Canadian Institutes of Health Research [Internet]. Ottawa (CA): Government of Canada. Institute of Health Services and Policy Research strategic plan 2009-2014; [date unknown] [revised 2010 Apr 8; cited 2013 Oct 30].
2. Canadian Institutes of Health Research [Internet]. Ottawa (CA): Government of Canada. CIHR-IHSPR strategic priority research areas; [date unknown] [revised 2013 Oct 16; cited 2013 Oct 30].
3. Redman S. Expert review team report for Institute of Health Services and Policy Research. Ottawa (CA): Government of Canada; 2011 Feb [revised 2011 Aug 2; cited 2013 Oct 26].
4. Hansen J, Schäfer W, Black N, Groenewegen P. European priorities for research on health care organizations and service delivery. J Health Serv Res Policy. 2011 Jul;16 Suppl 2:16–26.
5. Ettelt S, Mays N. Health services research in Europe and its use for informing policy. J Health Serv Res Policy. 2011 Jul;16 Suppl 2:48–60.
6. Canadian Institutes of Health Research [Internet]. Ottawa (CA): Government of Canada. SPOR SUPPORT units; [date unknown] [revised 2013 Nov 7; cited 2013 Oct 30].
7. Michael Smith Foundation for Health Research. Provincial health research plans: Summary. British Columbia (CA): MSFHR; [date unknown] (Unpublished).
8. Canadian Institutes of Health Research. SPOR health priorities. Canada: CIHR; 2013 Mar 8 (Unpublished).
9. Canadian Institutes of Health Research [Internet]. Ottawa (ON): Government of Canada. HSPR strategic research priorities; 2012 [revised 2013 Oct 16; cited 2013 Aug 8].
10. Canadian Institutes ofr Health Research. IAB input on future SPOR networks: Discussion guide. [place unknown]: CIHR; 2013 Mar 7 [cited 2013 Oct 28] (Unpublished).
11. Ipsos Reid. Canadian Institutes of Health Research strategy for patient-oriented research: Draft report: general public survey. [place unknown]: Ipsos Reid; 2013 Mar 6 [cited 2013 Oct 26] (Unpublished).
12. Ipsos Reid. Canadian Institutes of Health Research strategy for patient-oriented research: Summary of findings. [place unknown]: Ipsos Reid; 2013 Mar 25 [cited 2013 Oct 26] (Unpublished).

Appendix A: Asset Map Methodology

Appendix B: Pan-Canadian Health Services and Policy Research Jurisdictional Tables

This appendix provides a detailed overview of the assets and related organizations in each jurisdiction. The details included reflect a combination of analysis of data received from the 27 organizations as well as informant interview and related research activity. This constitutes a more detailed, combination of qualitative and quantitative data for each jurisdiction than is available in the online geo-map and is a richer reflection of the assets in Canada.

For each jurisdiction, the following six analyses are depicted.

1. Organizational Overview

List of Health Services and Policy Research organizations working in that particular jurisdiction. Organization names were listed by category with the primary function of each organization identified.

Categories for organizations include:

1. Universities
   • Centres embedded within universities and/or recognized within university as having special status as a centre, institute or within a department.
   • University has a charter defined in law.
2. Hospital/Health Region or Health Authority
   • Research to support organizations directly delivering health care or with a range of research interests.
3. Public Agencies and Government
   • Largely government funded with specific legislative supports or with government mandated responsibilities
4. Non-Governmental Organizations
   • Not for profit organizations that focus research to support specific diseases or conditions
5. Other

Functions for organizations include:

1. Fund Research
   • Provide financial support as part of a competitive process for conducting health services and policy research. Includes all forms of funding (chairs, grants, etc.) but not in-kind funding
2. Conduct Research
   • Conduct (investigator driven or policy/ decision maker led) health services and policy research activity that is subject to peer review at the point of application and/or publication
3. Use Research
   • Review and analyze research that has already been produced to document themes or generalize findings or ready for use by a specific audience. Includes knowledge translation, clinical decision support tools, briefing notes etc. Not research activity itself but creates a new product.
   • Develop evidence-based policies to guide health system and health service structure and/or delivery of services. Use of research as evidence to support to recommend (or not) specific course of action at either a policy or administrative level
   • Use of research as evidence for specific approach to delivery of or policies and decisions related to care.
4. Educate
   • Universities that explicitly offer health services and policy research degree programs
5. Support (Data Repository/ Data Support)
   • Organizations that collect, store and share data for the purpose or in support of health services and policy research
   • Organizations that promote and advance HSPR

2. Jurisdictional Profile

• Total value of funding received in each jurisdiction over five years, number of unique NPIs operating in each jurisdiction.

3. Funding by Funding Organization over five years

• List of organizations who funded projects in each jurisdiction along with the funding amount over five years and the percent of all funding that the funder represents.

4. Funding By Funding Type

• Funding mechanisms that have been received by organizations in each jurisdiction over the past five years with total value and percent of total.

5. Top Research Themes

• Top funded research themes in each jurisdiction with value and percent of total.

6. Research Activity Organizations

• List of organizations who received money, total funding received and number of projects.

British Columbia

Summary Overview

The following outlines the organizations involved in health services and policy research in this jurisdiction. rganizations identified by the funding data as a host organization (recipient of funding) are denoted with a *.

Health Services and Policy Research Activity in British Columbia

The following is an overview of the activity in this jurisdiction based on the asset map data.

Alberta

Summary Overview

The following outlines the organizations involved in health services and policy research in this jurisdiction. Organizations identified by the funding data as a host organization (recipient of funding) are denoted with a *.

Health Services and Policy Research Activity

The following is an overview of the activity in this jurisdiction based on the asset map data.

Saskatchewan

Summary Overview

The following outlines the organizations involved in health services and policy research in this jurisdiction. Organizations identified by the funding data as a host organization (recipient of funding) are denoted with a *

Health Services and Policy Research Activity

The following is an overview of the activity in this jurisdiction based on the asset map data.

Manitoba

Summary Overview

The following outlines the organizations involved in health services and policy research in this jurisdiction. Organizations identified by the funding data as a host organization (recipient of funding) are denoted with a *.

Health Services and Policy Research Activity

The following is an overview of the activity in this jurisdiction based on the asset map data.

Ontario

Summary Overview

The following outlines the organizations involved in health services and policy research in this jurisdiction. Organizations identified by the funding data as a host organization (recipient of funding) are denoted with a *.

Health Services and Policy Research Activity

The following is an overview of the activity in this jurisdiction based on the asset map data.

Quebec

Summary Overview

The following outlines the organizations involved in health services and policy research in this jurisdiction. Organizations identified by the funding data as a host organization (recipient of funding) are denoted with a *.

Health Services and Policy Research Activity

The following is an overview of the activity in this jurisdiction based on the asset map data.

* Represents networks that span multiple organizations within Quebec

New Brunswick

Summary Overview

The following outlines the organizations involved in health services and policy research in this jurisdiction. Organizations identified by the funding data as a host organization (recipient of funding) are denoted with a *

Health Services and Policy Research Activity

The following is an overview of the activity in this jurisdiction based on the asset map data.

Nova Scotia

Summary Overview

The following outlines the organizations involved in health services and policy research in this jurisdiction. Organizations identified by the funding data as a host organization (recipient of funding) are denoted with a *

Health Services and Policy Research Activity

The following is an overview of the activity in this jurisdiction based on the asset map data.

Newfoundland & Labrador

Summary Overview

The following outlines the organizations involved in health services and policy research in this jurisdiction. Organizations identified by the funding data as a host organization (recipient of funding) are denoted with a *

Health Services and Policy Research Activity

The following is an overview of the activity in this jurisdiction based on the asset map data.

Prince Edward Island

Summary Overview

The following outlines the organizations involved in health services and policy research in this jurisdiction. Organizations identified by the funding data as a host organization (recipient of funding) are denoted with a *

Health Services and Policy Research Activity

The following is an overview of the activity in this jurisdiction based on the asset map data.

National, Territories, & International

Summary Overview

The following outlines the organizations involved in health services and policy research at the national and international levels. International organizations that received HSPR funding from a Canadian organization are captured here. Organizations identified by the funding data as a host organization (recipient of funding) are denoted with a * This section is shorter than the others as some of the analyses did not align for this view of activity.

National

Health Services and Policy Research Activity

The following is an overview of the activity in this jurisdiction based on the asset map data.

Yukon Territory

International

Health Services and Policy Research Activity

The following is an overview of international activity based on the asset map data. Many funders do support international research, but that is typically done one of two ways, neither of which are represented within this report:

1. The funding flows to a researcher based at a Canadian institution who then carries out the research internationally or flows money from Canada to investigators in the other country
2. Parallel funding occurs – e.g., CIHR and a funder from another country co-fund a project, and CIHR’s dollars go to the Canadian investigators and the other funder’s dollars go to the researchers in their country, and then the two collaborate. This also happens for global health research.

Appendix C: Funding Data Overview

The following organizations provided yearly data and has been included in the trend analysis from 2008/9 through 2011/12). Where indicated, less than 4 years were provided:

• Michael Smith Foundation for Health Research
• Alberta Innovates – Health Solutions
• Saskatchewan Health Research Foundation
• Fonds de recherche du Québec - Santé
• New Brunswick Health Research Foundation (2009–2012)
• Nova Scotia Health Research Foundation
• Canadian Institutes of Health Research
• Heart & Stroke Foundation of Canada
• The Arthritis Society
• Alzheimer Society of Canada
• Pediatric Oncology Group of Ontario (POGO) – data provided by POGO
• Cystic Fibrosis Canada

The following organizations were excluded from the trend analysis because they did not provide yearly figures or the data was too complex to break out into component years.

• Cancer organizations (data provided by CCRA)
• Newfoundland & Labrador Centre for Applied Health Research
• Manitoba Health Research Council
• Canadian Foundation for Healthcare Improvement
• Canadian Foundation for Innovation & Canada Research Chairs (web based data)
• Ontario Ministry of Health and Long Term Care
• Canadian Diabetes Association
• Parkinson Society Canada
• Any data captured through key informant validation sessions

Appendix D: Research Themes & Funding Type

Theme areas were identified based on those that persisted throughout all three Listening for Direction¹¹ exercises (it was determined that theme areas that were identified in the 2001, 2004 and 2007 iterations of Listening for Direction – a national consultation on health services and policy issues that commenced in 2001 and ended in 2007 - were a reasonable basis for classifying investment over the period of the present report) and IHSPR’s priority research areas. An additional category called “Centre, network and infrastructure-related” was used to capture funds that flowed to large data centres and networks/centres lacking a domain focus. This category also included travel and journalism awards that could not be assigned to domain-related categories.

1. Primary and Community-Based Healthcare
2. Access to Appropriate Care across the Continuum
3. Governance and Accountability
4. Health Information (e-health)
5. Drug Policy
6. Health Care Financing and Funding/Health Economics
7. Managing for Quality and Safety
8. Change Management/Scaling up Innovation
9. Health Human Resources
10. Patient-Centered Care
11. Emerging Technology and Drugs (technology assessment)
12. Linking Population and Public Health with Health Services*
13. Knowledge Translation/ Implementation Science*
14. Health Information: Use of Administrative Databases*
15. Centres, networks and infrastructure-related

* Denotes new research theme developed during the initial review and classification process.

MeSH terms that were used for a bibliometric analysis in the same theme areas as well as IHSPR’s descriptions of its five priority research areas were used as a guide for the classification of projects by theme area. IHSPR’s descriptions are available on its website. The MeSH terms are available upon request.

Funding Type Listing

The following is a listing of the funding types that were assigned to records after reviewing the program name and funding type fields submitted by the funding organizations. Where possible, the most detailed funding type was assigned, however if it was unclear, the ‘general subtype (e.g. training award – general) was assigned. For example, if a salary funding type was not assigned as new investigator etc., the funding type is assigned as salary award – general. This reflects the variation in the level of detail shared by data providers.

• Research programs – General
• Research programs – Operating/project/program grant
• Research programs – Team grant
• Research programs – KT grant
• Research program – RCT
• Centres & Networks
• Training Award – General
• Training Award – Masters
• Training Award – Doctoral
• Training Award – Fellowship
• Salary Award – General
• Salary Award – New investigator
• Salary Award – Mid career
• Salary Award – Senior
• Salary Award – Clinician scientist
• Capacity & training grant
• Equipment & infrastructure grants
• Meeting, planning & dissemination grants
• Other

Appendix E: Universities with HSPR Training Centres

British Columbia

• University of British Columbia
• University of Victoria
• Simon Fraser University
• University of Northern British Columbia

Alberta

• University of Alberta
• University of Calgary

Saskatchewan

• University of Saskatchewan
• University of Regina

Manitoba

• University of Manitoba

Ontario

• McMaster University
• University of Toronto
• University of Ottawa
• York University
• Lakehead University
• Laurentian University
• Carleton University

Quebec

• McGill University
• Ecole nationale de l'administration publique (ENAP)

New Brunswick

• University of New Brunswick

Newfoundland & Labrador

• Memorial University of Newfoundland

Date modified:

2014-06-10