Shaping the future of healthcare in British Columbia: Establishing provincial clinical governance for responsible deployment of AI tools.

As healthcare embraces the transformative potential of Artificial Intelligence (AI), it is imperative to safeguard patient and provider safety, equity, and trust in the healthcare system. This article outlines the approach taken by the British Columbia (BC) Provincial Health Services Authority (PHSA) to establish clinical governance for the responsible deployment of AI tools in healthcare. Leveraging its province-wide mandate and expertise, PHSA establishes the infrastructure and processes to proactively and systematically intake, assess, prioritize, and evaluate AI tools. PHSA proposes a coordinated approach in AI tool deployment in collaboration with regional health authorities to prevent duplication of efforts and ensure equitable access to existing and emerging AI tools across the province of BC, incorporating principles of anti-Indigenous racism, cultural safety, and humility. The proposed governance structure underscores the identification of clinical needs, proactive ethics review, rigorous risk assessment, data validation, transparent communication, provider training, and ongoing evaluation to ensure success.

Cohort profile: the British Columbia COVID-19 Cohort (BCC19C)-a dynamic, linked population-based cohort.

Purpose: The British Columbia COVID-19 Cohort (BCC19C) was developed from an innovative, dynamic surveillance platform and is accessed/analyzed through a cloud-based environment. The platform integrates recently developed provincial COVID-19 datasets (refreshed daily) with existing administrative holdings and provincial registries (refreshed weekly/monthly). The platform/cohort were established to inform the COVID-19 response in near "real-time" and to answer more in-depth epidemiologic questions. Participants: The surveillance platform facilitates the creation of large, up-to-date analytic cohorts of people accessing COVID-19 related services and their linked medical histories. The program of work focused on creating/analyzing these cohorts is referred to as the BCC19C. The administrative/registry datasets integrated within the platform are not specific to COVID-19 and allow for selection of "control" individuals who have not accessed COVID-19 services. Findings to date: The platform has vastly broadened the range of COVID-19 analyses possible, and outputs from BCC19C analyses have been used to create dashboards, support routine reporting and contribute to the peer-reviewed literature. Published manuscripts (total of 15 as of July, 2023) have appeared in high-profile publications, generated significant media attention and informed policy and programming. In this paper, we conducted an analysis to identify sociodemographic and health characteristics associated with receiving SARS-CoV-2 laboratory testing, testing positive, and being fully vaccinated. Other published analyses have compared the relative clinical severity of different variants of concern; quantified the high "real-world" effectiveness of vaccines in addition to the higher risk of myocarditis among younger males following a 2nd dose of an mRNA vaccine; developed and validated an algorithm for identifying long-COVID patients in administrative data; identified a higher rate of diabetes and healthcare utilization among people with long-COVID; and measured the impact of the pandemic on mental health, among other analyses. Future plans: While the global COVID-19 health emergency has ended, our program of work remains robust. We plan to integrate additional datasets into the surveillance platform to further improve and expand covariate measurement and scope of analyses. Our analyses continue to focus on retrospective studies of various aspects of the COVID-19 pandemic, as well as prospective assessment of post-acute COVID-19 conditions and other impacts of the pandemic.

One-year effectiveness study of intravitreous bevacizumab in neovascular age-related macular degeneration: a population-based retrospective cohort study.

OBJECTIVE: To assess effectiveness of intravitreous bevacizumab in a cohort of patients with neovascular age-related macular degeneration (nAMD) in British Columbia, Canada. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with new-onset AMD who completed 1 year of bevacizumab treatment. METHODS: A cohort of 4507 patients with nAMD (5174 eyes) aged 50 years and older treated on an as-needed basis with bevacizumab was followed from June 1, 2010, to May 31, 2014, and then evaluated after completing a follow-up treatment at 1 year. Descriptive statistics were used to characterize eyes treated with bevacizumab. Multivariable regression models were used to quantify visual acuity (VA) changes over time, adjusting for baseline prognostic variables. RESULTS: On average, patients received 8.6 injections (SD 2.4) per eye during the year of treatment. There was an average gain of 5.2 letters over the 1-year study period. Among eyes treated with bevacizumab, improvement in VA was greater for eyes with poorer baseline VA and for eyes receiving more injections. The odds ratio for VA at 1 year was 9.35 (95% CI 6.00-14.6) for eyes with VA 20/50-20/80 versus 20/20-20/40 and increased to 74.5 (95% CI 47.7-116.4) for eyes 20/400 or worse versus 20/20-20/40. CONCLUSION: Intravitreous bevacizumab is effective in treating nAMD, especially for eyes with poor baseline VA. Gains in VA were greatest by month 3 and were generally maintained thereafter.