Erin Strumpf
Research
Recent and ongoing research projects which I lead as a principal or co-principal investigator:
Making the most of Canada's "natural laboratory": advancing difference-in-differences methods for unpoolable data (co-PIs E. Strumpf, N. Austin; CIs J. Daw, D. Rudoler, P. Saha Chaudhuri, M. Webb), funding CIHR.
Canadian provincial health systems have been called a “policy laboratory” where variations in health policies and health care system structure can be used to inform learning health systems and improve population health. Capitalizing on innovation and experimentation across Canadian health systems generates valuable opportunities for natural experiments and cross-jurisdictional comparative analyses to better understand what works – and what doesn’t. Difference-in-differences (DiD) estimation is a widely used and effective way to estimate causal effects and the impacts of policy changes in the absence of randomization. However, certain data sources are siloed by jurisdiction and cannot be combined into a single data set. The goal of this project is to develop "best practices" for conducting DiD analyses in the absence of pooled data. Our team, experts in econometrics, health economics, and health services and policy research, will develop methods to generate DiD estimates using econometric/statistical theory, simulated data, survey data that are not siloed across jurisdictions, and siloed administrative health data. The methods developed by this project will be relevant for both Canadian interprovincial comparisons and international comparisons.
The impacts of being formally enroled with a GP on continuity and integration of care: Evidence from a comparison of QC and BC (NPI E. Strumpf; PKUs A.Groulx, H. Davidson; Co-PIs L. Goldsmith, C. Loignon, K. McGrail; Patient Partner A. Bouchard; CIs M. Dumas Pilon, C. Hudon, F. Légaré, M-J. Ouimet, R. Lavergne) , funding: CIHR, Michael Smith Foundation, Quebec Ministry of Health, Réseau-1 QC, McGill University, CR-HCLM.
Some Canadian provinces have included patient enrolment with a GP as a foundation of their efforts to make primary health care more accessible, more continuous, and of higher quality. The idea behind patient enrolment – also called rostering or registration – is that all patients have a family doctor who takes responsibility for their care. Other provinces are currently considering such programs, while still others think they are not the best way to ensure accessible, timely health care for Canadians. Unfortunately, little is known about the actual benefits and costs of patient enrolment policies in Canada.
This research project brings together patients, providers, decision makers and researchers to provide a better understanding of how patient enrolment affects patient experiences, continuity and quality of care, and policy-relevant outcomes that are important for the sustainability of our health care systems. Because Quebec and British Columbia have already implemented patient enrolment programs, and because those programs are designed quite differently, we focus on those two provinces. We will talk to patients and family doctors to hear about their experiences and their priorities. We will also use health care data and statistical methods designed to evaluate policy interventions to understand what patient enrolment means for quality and continuity of care. We will try to understand if patient enrolment works better for some patients than for others, paying special attention to Canadians who need and use the health care system most. Our results will facilitate future cross-provincial studies of health care policy innovations and will support decision makers to build improved, patient-oriented, integrated health care and social services systems.
Health and Social Impacts on the Family Following Fetal/Infant Death (Co-PIs A. Lang, E. Strumpf; CIs S.L. Huckstep, J.M. Bolton, M.D.; D. Chateau, M.B. Doupe, G.S. Finlayson, M.I. Heaman, J. Sareen), funding: CIHR.
The purpose of this study is to determine, at a population level, the mental health consequences, physical health consequences and social consequences for family members (parents and siblings) following fetal/infant death and their impact on health services utilization. This study is the first to examining the impact of the death of a baby from a population health or health services use perspective in Canada. A better understanding of the risks and negative sequelae experienced by bereaved parents and families is needed to design effective interventions to mitigate them and to convince policy and decision makers of the need for action in this area. Bereavement care must be integral to healthcare agendas and services and improvements require a large system change through effective knowledge translation strategies, with key stakeholders across sectors and provinces.
Primary care reform and medication appropriateness for seniors: A comparative study of two provinces (co-PIs S. Allin, E. Strumpf, A. Grudniewicz, E. Martin, D. Rudoler, CIs L. Dolovich, R. Glazier, A. Laporte, G. Marchildon), funding CIHR.
Seniors are at high risk for inappropriate prescription of medication, which can result in declining health and increased burden on the health care system. It has been suggested that improving primary care by implementing interdisciplinary team-based care could decrease the incidence of inappropriate prescription, however evidence is limited. In this comparative study, we will use complementary qualitative and quantitative methods to look at the impact of the recent primary care reforms in Ontario and Quebec respectively on medication management. The results of this project with help inform future policy on primary health care reforms and determine whether interdisciplinary team-based care is an effective way to reduce inappropriate prescription of medication.
Short term benefits but long term harm? Assessing the consequences of antenatal corticosteroid administration for child neurodevelopment (Co-PIs S. Harper, J. Hutcheon, E. Strumpf, CIs A. Skoll, M. Srour), funding: CIHR.
Randomized clinical trials have clearly demonstrated that administration of antenatal corticosteroids to women at risk for preterm labor reduces neonatal mortality and risk of respiratory illness at birth. In recent years, the long-term effects of this treatment have come into question as some studies suggest antenatal steroid administration may be detrimental to child neurodevelopment. However, there is insufficient high-quality evidence from randomized trials to confirm that antenatal corticosteroid administration increases risk of neurodevelopmental issues. In this project, we use regression discontinuity to provide causal estimates for the impact of antenatal corticosteroid administration on kindergarten child development scores and development of neurodevelopmental disorders including Cerebral Palsy and Attention Hyper Deficit Disorder (ADHD). Our findings will provide a more accurate, rigorous assessment of the safety of antenatal corticosteroid use on long term health outcomes.