Health System News sat down with Dr. David Rudoler, Inaugural Research Chair in Population Health and Innovation in Mental Health at Ontario Shores Centre for Mental Health Sciences (Ontario Shores), in partnership with the University of Toronto, Dalla Lana School of Public Health (DLSPH). Dr. Rudoler, who was appointed to this new role earlier this year, spoke about why this work is critical, researchers who have made important strides in this area and what he hopes to contribute.
As the province continues to navigate the pandemic, lessons have emerged, particularly in terms of gaps in health equity and care. These insights will help build an even stronger health system, one which includes a deliberate focus on achieving greater health equity, integration of health and social services, and initiatives that contribute to the overall improvement of the health of the population. This article is the second in a series exploring the concept of population health, with the goal of considering the role of a hospital in producing population health. This series will feature successful initiatives of health systems that have invested beyond their walls to improve the health of their communities. To read the first article in the series, click here, and to visit the population health resource page, click here.
Q: Can you tell us a bit about yourself – your experience in the area of population health, mental health more specifically, and what led you to this role?
A: I actually started off in government, where I worked in public policy. I ended up completing my PhD in health system research and health economics at the University of Toronto. My doctoral work focused on primary care and population health, specifically on payment incentives for primary care physicians and access to care for persons with complex health and social needs. It's only after I started working at the Centre for Addiction and Mental Health (CAMH) when my interest in this area grew. Ever since then, I've been straddling research in primary care and mental health and addictions.
I know that Ontario Shores is very much committed to developing a better and more holistic understanding of the factors that influence a person's mental health. For this reason, we need to also look beyond the hospital's four walls to include the community – how to promote wellness, preventative care, for example – in order to more successfully address mental illness earlier on. Ultimately, it's about providing high-quality and appropriate care, wherever that may be. The good news is that Ontario Shores has built a solid foundation in terms of enabling data collection, having invested a lot of time and effort into optimizing their electronic health records (EHR) to advance population health and better support clinical practice. They've also worked hard to bring innovation to this work, and together with The Royal in Ottawa and Waypoint Centre for Mental Health Care, they collaborated on a shared EHR, to expand the first mental healthcare EHR hub in Ontario. This is already a great advancement. To build on this work, further improve patient outcomes and address health inequities, providers need to gather more data to better understand how to design effective and responsive services and supports not just in hospitals, but across the continuum. We want to know who's coming to the hospital. What services do they tap into before then, and where they go after they leave? Who's not accessing care and ending up in hospital?
To me, this work is vital for few reasons. Until now, mental health and addictions hasn't received attention that's commensurate with the burden that mental illness has on the population. So many struggle with mental illness and addictions challenges which has significant implications for the health and social services systems. Related to the last point, there isn't a lot of research in this area compared to other areas in population health research. So, there is a need and an opportunity to contribute. But, that's the academic side of things. Ultimately, the research is a means to an end. The research can't lose sight of the human element; there are individuals dealing with mental illness and addiction, and the research has to be connected to improving their well-being and opportunities for recovery.
Q: What do you think is unique about mental health and addictions when thinking about population health?
A: I think that diagnosis is more difficult compared to other chronic conditions like diabetes, for example. This makes it challenging to know who struggles with mental health and addictions challenges and where the need is. As well, the stigma around mental illness is still real. This may lead people to avoid seeking help when they need it, which adds to the difficulty of assessing the need for services and supports and ensuring adequate supply is available. I also think that how much research funding is invested into mental health and addictions depends on how we prioritize it as a province, system and society. Unfortunately, fewer resources are available for this work. These are challenges, for sure. But, there is a great deal of opportunity as well – opportunity to gain clearer answers to the questions around diagnosis, population burden, and equitable access to appropriate care. There's also great opportunity to evaluate promising interventions across the care continuum that can support people along their journey to recovery. All of these elements are important components of population health.
Q: What are your intentions for this new role?
A: My primary focus will be on research, but this requires a large team effort. So, I see myself as someone who can leverage the position to bring people together who are interested in the same thing.
In terms of research, there are a few things I want to investigate. As I said before, I want to know more about what's happening outside the hospital, such as where patients go after they leave. It's so important for patients to feel re-integrated into their communities by giving them a stable, safe place to live and work, or offering them the opportunity to gain new skills. There's little in terms of evidence about what works for this population.
I'm also interested in primary health care as it's one of the key places people go to receive mental health care, as well as psychiatry services. There's good evidence around integrating mental health supports and services within primary care, but I want to know at what point patients seek help – before hospital, once they leave the hospital, etc. More can be done at a regional level to acquire a granular-level understanding of individual behaviours and patterns which are critical to planning efforts.
Finally, I want to take advantage of the available data through Ontario Shores to help inform care within the hospital in order to support clinicians on the frontlines who have intimate knowledge about gaps in care. They can pose the questions, and as a scientist, together with a team, we can do the research to help answer them. I think it's also equally important to foster strong partnerships between Ontario Shores and community providers to do the same thing because they have a different lens about care needs in the community and can pose valuable research questions.
Q: In your opinion, what is a hospital's role in producing population health?
A: In Ontario, historical circumstances resulted in a system primarily built around hospitals. As result, hospitals are the largest health care provider organizations within their communities. The biggest among them typically have the resources and capacity to collect data and conduct research that can inform decision-making. So, hospitals have a very important role to play in this respect, and many have and are already working with community partners to improve access and outcomes for their patients and clients. By also engaging community partners to lead or develop research questions, we can accomplish much more to enhance quality of care.
While there aren't a lot of provincial models with respect to mental health and population health, we can learn from those that have succeeded in other areas, like the former Cancer Care Ontario which has been integrated into Ontario Health (OH). Their model enabled providers to extend care outside hospitals into the community.
Finally, when it comes to research efforts and what's been accomplished to date, there are two leading figures who've inspired me. Dr. Muhammad Mamdani, Vice President of Data Science and Advanced Analytics at Unity Health Toronto, has been doing amazing work in the area of data analytics. Often research and analytics aren't well-integrated with clinical work and decision-making on the front lines. The folks at Unity Health, led by Dr. Mamdani, have developed a process for integrating research with clinical decision-making and have demonstrated that this partnership can have measurable impacts on patient outcomes.
Also top-of-mind is Dr. Paul Kurdyak, Director of Health Outcomes and Performance Evaluation in the Institute for Mental Health Policy Research and Medical Director of Performance Improvement at CAMH. He is also Lead of the Mental Health and Addictions Research Program at the Institute for Clinical Evaluative Sciences (ICES). Dr. Kurdyak created a dedicated analytics program for mental health and addictions at ICES, which allowed him to develop performance indicators used to gauge the effectiveness of interventions at a population level. People working with Dr. Kurdyak and ICES continue to develop ways to assess population prevalence of mental illness in Ontario. It's only been possible to do this work because the infrastructure is in now place thanks to Dr. Kurdyak's leadership. He's helped pave the way for ongoing research in this area.
Q: Can you summarize for us at high-level what this work is about, why it's important, and how patients and clients can benefit?
A: My job is to identify population needs, gaps in services, and where there are gaps, develop and rigorously evaluate interventions, to provide people with better access and evidence-based care. I believe in primarily using data to inform decisions. Patients also stand to benefit by getting more timely access to care so they don't end up in hospital if they don't have to be there. And if they need to be, these data will help to inform clinicians about the care they provide and how to improve these services and supports. This work will also help to ensure that patients can get a hold of appropriate supports when they leave the hospital, like safe and accessible housing and opportunities.
In addition to his role as Inaugural Chair, Dr. Rudoler is also Assistant Professor at both the Ontario Tech University and U of T's Institute for Health Policy, Management and Evaluation.