Community hospitals provide care to the majority of Canadians.
The participation of community hospitals in research is essential if we wish to accelerate knowledge generation and knowledge mobilization, and ensure that Canada’s diverse population is appropriately represented in clinical research studies. The advocacy of Dr. Tsang, the principal investigator of this program, has included both academic and grassroots organizing efforts. She has authored four op-eds calling for the inclusion of community hospitals in research.
Dr. Tsang's op-eds
Ross, K., Tsang, J. (2017). It’s time to increase community hospital-based health research. Academic Medicine, 92, 727.
Gehrke, P., Binnie, A., Chan, S., Herridge, M., Cook, D.J., Burns, K.E.A., Tsang, J. (2019). Fostering community hospital-based research. Canadian Medical Association Journal, 191, E962- E966.
Tsang, J.L.Y., Binnie, A., Farjou, G., Fleming, D., Khalid, M., Duan, E. (2020). Participation of more community hospitals in randomized trials of treatments for COVID-19 is needed. Canadian Medical Association Journal, 192, E555.
Tsang, JLY., Fowler, R., Cook, D.J., Ma, H., Binnie, A. (2021). How Can We Increase Participation in Pandemic Research in Canada? Canadian Journal of Anesthesia.
In 2019, Dr. Tsang, along with Dr. Alexandra Binnie from William Osler Health System, co-founded the Canadian Community ICU Research Network (CCIRNet), an association of Canadian community ICU professionals with an interest in clinical research. The goal of CCIRNet is to foster a culture of research in community hospital ICU settings across Canada with the aim of increasing patient enrolment and improving the generalizability of study results. CCIRNet aims to break down the barriers that have traditionally existed between academic and community hospitals at the research level with the hope this will lead to better care for our patients.
By sharing knowledge and experience, CCIRNet hopes to support community hospital ICUs in achieving their research goals. Thus far, CCIRNet has 60 members representing 26 community hospitals across six provinces. We have developed a toolkit to help grow the network: A Guide to Building a Community Hospital Clinical Research Program: Strategies from a Multidisciplinary Front-line Perspective. Kian Rego, a research co-ordinator at the Niagara Health Knowledge Institute (NHKI), is working to disseminate this toolkit across Canada.
During the COVID-19 pandemic, Dr. Tsang, along with a team of researchers in Canada led by Dr. Fowler from Sunnybrook Health Sciences Centre, obtained a $10 million CIHR grant to support the COVID-19 Network of Clinical Trials Networks (NoN).
As part of this work, Dr. Tsang is a member of the COVID-19 NoN Steering Committee and she co-chairs the COVID-19 NoN Community Acute and Critical Care Working Group, which have a mandate to increase research capacity and activity in community hospitals across Canada through financial and infrastructural support. Currently, 16 community ICU research programs are supported by COVID-19 NoN.
Dr. Jennifer Tsang
Principal Investigator
Dr. Alexandra Binnie
ICU Research Physician Lead and Intensivist, William Osler Health System
During the COVID-19 pandemic, Dr. Tsang led a national survey, funded by the Canadian Critical Care Trials Group (CCCTG) Early Career Research Award, examining the motivating factors, barriers and facilitators of community hospital ICU participation in COVID-19 clinical trials.
Read Dr. Tsang's national survey
Tsang, JLY., Fowler, R., Cook, D.J., Burns, K.E.A., Hunter, K., Forcina, V., Hwang, A., Duan, E., Patterson, L., Binnie, A (2022). Motivating Factors, Barriers and Facilitators of Participation in COVID-19 Clinical Research: A Cross-Sectional Survey of Canadian Community Intensive Care Units. PLOS One.
Dr. Tsang recently completed a cohort study comparing patient characteristics, outcomes and trial metrics of community ICUs vs academic ICUs participating in the CIHR-funded PROSPECT multi-centre RCT. Her work demonstrated that patients enrolled from community ICUs are different from those enrolled from academic ICUs and that community ICUs can conduct clinical trials as well as academic ICUs.
Dr. Tsang's cohort study
Tsang JLY, Binnie A, Duan EH, Johnstone J, Heels-Ansdell D, Reeve B, Trop S, Hosek P, Dionne JC, Archambault P, Lysecki P, Cirone R, Zytaruk NL, Dechert W, Camargo MP, Jesso R, McMillan E, Panchbhaya Z, Campbell T, Saunders L, Copland M, Kavikondala K, Cook DJ. (2022). Academic and Community ICUs Participating in a Critical Care Randomized Trial: A Comparison of Patient Characteristics and Trial Metrics. Critical Care Explorations. 4(11): e0794.
Dr. Tsang is leading a national qualitative study, funded by the Physicians’ Services Incorporated (PSI) Foundation, to explore the factors influencing Canadian community hospital ICU involvement in health research. Paige Gehrke, an ICU nurse at Niagara Health, who recently obtained her Master of Science in Nursing Degree from McMaster University, was lead research co-ordinator on this study. Kian Rego was the Research Student on this study.
In collaboration with Dr. Alexandra Binnie, Dr. Tsang is co-leading a cohort study comparing the characteristics and outcomes of COVID-19 patients cared for in community vs academic ICUs in Ontario. This study is funded by PSI Foundation. Daniel Pestana, research assistant at Algarve Biomedical Centre in Faro, Portugal, conducted this study under the co-supervision of Dr. Tsang and Dr. Binnie.
In collaboration with Madelyn Law, Director of Quality, Patient Safety and Risk, Dr. Tsang and Dr. Binnie are co-supervising a Post-Doctoral Fellow, Elaina Orlando, who is also the Research Manager at NHKI, on a case study to understand the COVID-19 NoN Community Acute and Critical Care Working Group’s efforts to increase research capacity in Canadian community hospitals using the consolidated framework for implementation research. This study is supported by CIHR through COVID-19 NoN Post-Doctoral Fellowship Fund.
Kian Rego, Research Co-ordinator
Elaina Orlando, Post-Doctoral Fellow
Dr. Tsang is also a co-investigator for the Life-Threatening Illness National Group (LifTING) Research Training Platform (funded by CIHR). Her role is to provide mentorship and develop training programs for researchers in community hospitals. She is also a member of the Ontario Hospital Association’s Hospital-Based Co-ordination Working Group with a mandate to build research capacity in Ontario hospitals, including community hospitals.
Most recently, Dr. Tsang obtained external funding from COVID-19 NoN (CIHR) to support a McMaster University undergraduate student to examine the feasibility of using a simplified biological sampling protocol in translational biology study. The goal is to make translational biology study more feasible in community hospitals where there are limits in biological sample processing.
Lastly, Dr. Tsang led an international team of scientists in submitting a CIHR grant application in March 2023 entitled Precision Medicine in Community Acquired Pneumonia (CAP) to examine whether: 1) molecular endotypes could predict corticosteroid response in patients with severe CAP; 2) biological sample collection is feasible in community hospitals; and 3) a “simplified” bio-sampling protocol would generate samples that are adequate for proteomic, transcriptomic and DNA methylation analysis.
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