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Braeden A Terpou,1 Marissa Bird,1,2 Diya Srinivasan,1 Shalu Bains,3 Laura C Rosella,1,4 Laura Desveaux1,2 1Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; 2Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; 3Mississauga Hospital, Trillium Health Partners, Mississauga, Ontario, Canada; 4Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, CanadaCorrespondence: Laura Desveaux, Institute for Better Health, Trillium Health Partners, 2085 Hurontario Street, Mississauga, ON, L5B 1B8, Canada, Tel +1 437772-6836, Email Laura.Desveaux@thp.caPurpose: As the COVID-19 pandemic recedes, the importance of population health has come into sharp focus, prompting many health systems to explore leveraging population health data (PHD) for operational planning. This approach requires that healthcare leaders embrace the dual priorities of maintaining excellence in patient care while promoting the overall health of populations. However, many leaders are new to population-based thinking, posing a threat to successful operationalization if mental models are not aligned.Patients and Methods: This qualitative case study explored the alignment of mental models among 13 senior leaders at Trillium Health Partners (THP), one of Canada’s largest community hospitals, as they embark on embedding PHD within operational workflows.Results: All leaders recognized the necessity of adopting a population health approach amid resource constraints and growing pressures. When discussing the operationalization of PHD, two distinct mental models emerged among leaders: one focused on patient care and the other on population health. While executive leaders demonstrated a fluidity in their thinking between the two, programmatic leaders favoured one over the other. For example, some viewed the organization’s focus on PHD as competing with their patient care responsibilities, while others saw the use of PHD as a solution to the organization’s operational pressures. Despite these divergences, leaders unanimously stressed the importance of increasing the organization’s risk tolerance and devolving decision-making as a necessary precursor to realizing the transformation to a PHD-driven approach.Conclusion: These divergent mental models highlight a need to clarify the shared vision for the use of PHD along with its impact on leadership roles and accountabilities. These findings illustrate the current state from which THP aims to evolve and underscore the importance of aligning leaders’ mental models as a critical step to facilitating successful integration of PHD and advancing a collective vision for healthcare transformation.Keywords: health equity, population health management, healthcare leaders, qualitative study

Preeya K Gupta,1,2 Rolando Toyos,3 John D Sheppard,4 Melissa Toyos,3 Francis S Mah,5 Brian Bird,6 Pamela E Theriot,7 Don Higgins8 1Triangle Eye Consultants, Raleigh, NC, USA; 2Department of Ophthalmology, Tulane University, New Orleans, LA, USA; 3Toyos Clinic, Nashville, TN, USA; 4Virginia Eye Consultants, Norfolk, VA, USA; 5Scripps Clinic, La Jolla, CA, USA; 6Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA; 7Lusk Eye Specialists, Shreveport, LA, USA; 8Dry Eye Treatment Center of Connecticut, Plainville, CT, USACorrespondence: John D Sheppard, Virginia Eye Consultants, 241 Corporate Blvd, Norfolk, VA, USA, Tel +1 757 622-2200, Fax +1 757 622-4866, Email jsheppard@cvphealth.comAbstract: Dry eye disease (DED) is a common, multifactorial ocular disease impacting 5% to 20% of people in Western countries and 45% to 70% in Asian countries. Despite the prevalence of DED and the number of treatment approaches available, signs and symptoms of the disease continue to limit the quality of life for many patients. Standard over-the-counter treatment approaches and behavior/environmental modifications may help some cases but more persistent forms often require pharmacological interventions. Approved and investigational pharmaceutical approaches attempt to treat the signs and symptoms of DED in different ways and tend to have varying tolerability among patients. While several pharmacological approaches are the standard for persistent and severe disease, mechanical options provide alternate treatment modalities that attempt to balance efficacy and comfort. Newer approaches target the causes of DED, utilizing novel delivery methods to minimize irritation and adverse events. Here, we review approved and investigational approaches to treating DED and compare patient tolerability.Keywords: dry eye disease, tolerability, safety, pharmaceutical interventions, mechanical interventions

Meghan J Bird,1,2 Grace Li,3 Andie MacNeil,1,2 Ying Jiang,4 Margaret de Groh,4 Esme Fuller-Thomson1,2,5,6 1Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada; 2Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada; 3Department of Sociology, University of Victoria, Victoria, BC, Canada; 4Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada; 5Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 6Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, CanadaCorrespondence: Esme Fuller-Thomson, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada, Tel +1 416 978-3269, Fax +1 416 978-7072, Email Esme.fuller.thomson@utoronto.caPurpose: The objectives of this study were to identify the prevalence of, and factors associated with, incident and recurrent depression in a sample of older adults with a history of cancer during the COVID-19 pandemic.Materials and Methods: Data were drawn from four waves of the Canadian Longitudinal Study on Aging Comprehensive Cohort (n=2486 with cancer). The outcome of interest was a positive screen for depression based on the CES-D-10 during the autumn of 2020.Results: Among older adults with cancer and no pre-pandemic history of depression (n=1765), 1 in 8 developed first onset depression during the pandemic. Among respondents with cancer and a history of depression (n=721), 1 in 2 experienced a recurrence of depression. The risk of both incident and recurrent depression was higher among those who were lonely, those with functional limitations, and those who experienced an increase in family conflict during the pandemic. The risk of incident depression only was higher among older women, those who did not engage in church or religious activities, those who experienced a loss of income during the pandemic, and those who became ill or had a loved one become ill or die during the pandemic. The risk of recurrent depression only was higher among those who felt isolated from others and those whose income did not satisfy their basic needs.Conclusion: Health care providers should continue to screen and provide mental health support to their cancer patients and those with a lifetime history of cancer, with consideration for those with the aforementioned vulnerabilities.Keywords: COVID-19, depression, cancer, older adults, CLSA