Latest articles about Chronic Care http://www.longwoods.com http://blogs.law.harvard.edu/tech/rss Mon, 17 Nov 2008 13:34:46 -0500 Mon, 17 Nov 2008 13:10:42 -0500 FeedForAll v2.0 (2.0.2.9) http://www.feedforall.com This study explored the effects of out-of-pocket expenditures on antidepressant use among workers receiving depression-related short-term disability benefits. The authors examine the association between workers' out-of-pocket expenditures prior to their disability episode and their use, or delay in use, of antidepressants during the episode. http://www.longwoods.com/product.php?productid=20271&cat=572&page=1 003D20EE-E800-43C1-A944-F052DFC9E33A Mon, 17 Nov 2008 13:10:42 -0500 This health technology assessment examines vascular ultrasound screening for abdominal aortic aneurysm (AAA) in asymptomatic populations. Screening reduces the incidence of AAA ruptures, rates of emergency surgical repair and AAA-attributable mortality in males ages 65 to 74. The benefit of screening women has not been established. Ontario data suggest that AAA is underdiagnosed in women, and that women are systematically undertreated. Targeting smokers for screening was found to maximize cost-effectiveness. Economic analysis found that screening may generate savings from the avoidance of emergency surgeries. Based on these findings, the Ontario Health Technology Advisory Committee has recommended screening for AAA in both male and female ever-smokers ages 65 to 74. http://www.longwoods.com/product.php?productid=20263&cat=572&page=1 B6766EBE-12C6-4A6F-9D5E-1001992E1A31 Mon, 17 Nov 2008 13:06:24 -0500 Increasing health and economic costs of overweight and obesity underscore the urgency of finding effective means of addressing the problem. There is broad support within the public health community for approaches that are holistic in nature, taking into account a host of factors that make up the food environment and ultimately influence individual behaviours. Policies with the power to support substantial and even radical changes in the food environment will require a high degree of political will, a systems approach and global co-operation. Small steps are unlikely to produce adequate results. Change of this magnitude will require newly developed and effectively deployed leadership capacities, particularly within our senior public health workforce. http://www.longwoods.com/product.php?productid=20177 CEB69C73-10FF-4545-B5C8-A5975674F62B Thu, 30 Oct 2008 09:50:08 -0400 Multi-sector, broad legislative support for obesity policy is of critical importance to successful system-level implementation and sustainability. To win such support, policy-makers should consider the adoption of a "post-partisan" decision-making process and governance structure whose features include: the involvement of multi-sector and cross-partisan decision-makers from the very beginning of planning and policy debate; the necessity that all participants disclose their competing interests; and the use of analytical techniques to synthesize and select the most innovative ideas from among all those considered. Post-partisanship therefore differs from traditional political compromise; it is an action-oriented, values-based model that embraces an aggressive commitment to collaboration, innovation, intellectual diversity, and building ongoing relationships across sectors and across partisan lines in order to pursue lasting public health solutions. http://www.longwoods.com/product.php?productid=20178 CEB69C73-10FF-4545-B5C8-A5975674F62B Thu, 30 Oct 2008 09:50:08 -0400 Public policy aimed at reducing obesity is just one of many avenues that must be pursued to address the still-growing obesity pandemic. The complexity of the problem is illustrated in ecological frameworks and system maps of the determinants. These conceptual maps illustrate the complexity by acknowledging the influence of many different factors such as social norms and values; sectors of influence such as the food and beverage industries, media and transportation; behavioural settings including home and family, school and community; and individual factors such as genetics, psychosocial and other personal elements. But to solve such a complex problem, we need to move from an analysis of the determinants or causes of the problem to a solution orientation; the frameworks used to describe the problem may not be the right ones for building the "best" solutions. Solution-oriented frameworks, like those presented by Hobbs and Seeman, have been based on parameters such as the sector of influence (e.g., public policy) but would benefit from the consideration of complexity and the leverage points for intervention in complex systems, which are a function of parameters such as the structure of relationships and the presence or absence of feedback loops. http://www.longwoods.com/product.php?productid=20184 CEB69C73-10FF-4545-B5C8-A5975674F62B Thu, 30 Oct 2008 09:50:08 -0400 One's weight is the outcome of a complex interplay of factors within which the choices we make about diet and activity are constrained and shaped by systemic forces - biological, social and economic - that fall increasingly beyond our control. "Simple" solutions that ignore the complex, systems-level characteristics of the obesity epidemic will generally fail as counter-veiling forces act to negate and undermine whatever action is taken. Selling the prevention message is not enough if politicians can choose conservative options that give the appearance of action but fail to tackle the issue. They need instead to be convinced that there is no alternative other than the multi-sector, multi-level, whole-of-government approach that is being adopted by enlightened jurisdictions such as California and the United Kingdom. As Dr. Havala Hobbs argues, this requires transparency, public participation, accountability and politically astute leadership of the sort demonstrated in the fight against tobacco. http://www.longwoods.com/product.php?productid=20179 CEB69C73-10FF-4545-B5C8-A5975674F62B Thu, 30 Oct 2008 09:50:08 -0400 Suzanne Hobbs and Neil Seeman have written thoughtful and thought-provoking papers on the interrelationships between public policy and the management of the current obesity epidemic. In this commentary, I discuss their respective arguments and offer my own perspectives. There is no shortage of ideas on addressing the obesity epidemic; the difficulty lies in determining which of the proposed interventions shows promise. Ultimately, a long-term approach is required - losing weight is a slow business. http://www.longwoods.com/product.php?productid=20180 CEB69C73-10FF-4545-B5C8-A5975674F62B Thu, 30 Oct 2008 09:50:08 -0400 Policy that creates supportive, health-enabling environments to assist people to make healthy choices in relation to food consumption and physical activity is urgently needed. Havala Hobbs and Seeman highlight the challenges of obtaining obesity policy on political agendas. Policy solutions exist; however, they involve action from mainly non-health sectors. The role of public health professionals in making this a reality will be discussed. Public health needs to increase the capacity of the sector to advocate for political support and work collaboratively to develop policy between, not just within, sectors. Leadership and political nous are necessary to gain the political support required to allow supportive environments to become a reality. http://www.longwoods.com/product.php?productid=20181 CEB69C73-10FF-4545-B5C8-A5975674F62B Thu, 30 Oct 2008 09:50:08 -0400 Solving the obesity crisis has less to do with post-partisanship and more to do with increasing public support for strong public policy initiatives that will make the healthy choice the easy choice. The government has an important role in mitigating the toxic food environment created by food manufacturers and restaurant chains. Progress to date has occurred on the state level. With greater public support in a new political environment, national progress may be possible in the foreseeable future. http://www.longwoods.com/product.php?productid=20182 CEB69C73-10FF-4545-B5C8-A5975674F62B Thu, 30 Oct 2008 09:50:08 -0400 "They don't understand how this could happen. I tell them that they have crushed their knees under their own weight." http://www.longwoods.com/product.php?productid=20183 CEB69C73-10FF-4545-B5C8-A5975674F62B Thu, 30 Oct 2008 09:50:08 -0400 In our complementary essays, we make three basic observations that we suggest will be helpful for the design of effective obesity policy. First, we acknowledge that we are only beginning to understand the complex bio-social-cultural determinants of obesity. Despite best intentions, some policy interventions will fail (and have failed). Second, given what we know to be the multi-factorial determinants of obesity, finding intelligent policy solutions requires a strategic decision-making framework that hypothesizes the web-like interrelationships among the host of variables that current evidence tells us contributes to unhealthy weights. Third, the process of implementing effective obesity policy is, by definition, political. As such, health policy advocates and health professionals need a basic understanding of the policy arena in which they fit and must acquire the necessary political skills to influence policy making processes. Seeman contends that a new kind of post-partisan decision-making needs to emerge whereby diverse decision-makers come together from the outset of planning and policy debate; whereby decision-makers feel unencumbered to disclose their competing interests; and whereby validated analytical techniques are used to synthesize and select the most innovative, unbiased and criteria-based ideas from among all those considered. Hobbs emphasizes the need for developing and effectively deploying leadership capabilities, particularly within our senior public health workforce. http://www.longwoods.com/product.php?productid=20185 CEB69C73-10FF-4545-B5C8-A5975674F62B Thu, 30 Oct 2008 09:50:08 -0400 The Balanced Scorecard (BSC) is a performance-monitoring framework that originated in the business sector but has more recently been applied to health services. The province of Ontario is using the BSC approach to monitor quality of inpatient care in five service areas. Feasibility of the scorecard framework for each area has been assessed using a standard approach. This paper reports results of the feasibility study for the mental health sector, focusing on three issues: framework relevance, underlying strategic goals and indicator selection. Based on a literature review and extensive stakeholder input, the BSC quadrant structure was recommended with some modifications, and indicators were selected that aligned with provincial mental health reform policy goals. The mental health report has completed two cycles of reporting, and has received good support from the field. http://www.longwoods.com/product.php?productid=19898 CEB69C73-10FF-4545-B5C8-A5975674F62B Fri, 20 Jun 2008 09:50:08 -0400 Asthma is the most common chronic childhood disease, and evidence suggests that children underutilize inhaled corticosteroid ("controller") medications. Drug plans that provide benefits to children vary widely across Canada, and families may face high out-of-pocket costs. As an initial step in a knowledge exchange process aimed at motivating relevant research, a workshop was convened in March 2007 with diverse stakeholders to explore potential research topics within the theme of improving drug benefits for Canadian children with asthma. Six key challenges for further investigation were identified: (1) changing the perception of asthma from an episodic to a chronic disease, (2) improving diagnosis and management, (3) increasing intersectoral communication, (4) improving the quality of data, (5) developing better drug benefit plans and (6) practising more effective advocacy. http://www.longwoods.com/product.php?productid=19922 F9305A1D-14F4-45DF-B11F-B8A558326994 Fri, 20 Jun 2008 09:49:33 -0400 This paper analyzes the migration patterns of both Canadian medical school graduates and international medical graduates (IMGs), and the impact of these patterns on physician supply in Canada. Immigration patterns of IMGs have changed over time, with fewer physicians from the United Kingdom and more from South Africa. A large portion of IMGs who leave Canada (43%) return "home." Recently, the average duration of practice in Canada for these doctors has been three years, a finding that suggests many came for educational purposes or to acquire skills. The heterogeneity and complexity of international migration are highlighted in this paper. http://www.longwoods.com/product.php?productid=19899 72B92899-006D-4D56-BA15-19D58948F6A0 Fri, 20 Jun 2008 09:48:50 -0400 On St. Valentine's Day 2006, the BC provincial government promised public discussions on healthcare. The ensuing Conversation on Health wrapped up last July. Meanwhile, the province has pursued more privately financed health construction projects (P3s) and tolerated expansion of the private healthcare subsector. The author reviews the differences between public consultation processes and the Conversation on Health, concluding that the principal aim of the BC government exercise was co-optation. http://www.longwoods.com/product.php?productid=19917 1367270E-536D-4AC6-80F0-76F619E3669B Fri, 20 Jun 2008 09:48:04 -0400 About 40 years ago, Thomas McKeown demonstrated that the historic decline in the great killer diseases owed little or nothing to progress in medicine. A generation of research on population health followed, highlighting the large social gradients in health within populations. These vary greatly across societies, but appear largely unrelated to medical care. Medicine was acknowledged as "powerful, but within limits"; the major determinants of health lie elsewhere. http://www.longwoods.com/product.php?productid=19916 EA294BCD-EC6B-45E1-97E3-0571EE781C94 Fri, 20 Jun 2008 09:47:39 -0400 Australia, New Zealand, the United Kingdom and the United States have followed different policy paths regarding medication use in nursing homes. The authors draw policy lessons from a comparison of approaches. http://www.longwoods.com/product.php?productid=19560 7875BC0E-BFB4-482F-892A-5E05D912B359 Wed, 27 Feb 2008 10:15:51 -0500 St. Peter's Residence at Chedoke in Hamilton, Ontario, a 210-bed long-term care facility, is building the capacity of front-line employees to become engaged in quality improvement. With training and tools, teams made up of front-line and other staff are becoming engaged in creating a quality improvement culture. This innovative initiative was recently featured in Promising Practices in Research Use, a series produced by the Canadian Health Services Research Foundation highlighting organizations that have invested their time, energy and resources to improve their ability to use research in the delivery of health services. http://www.longwoods.com/product.php?productid=19573 6257F666-1A25-4128-A37C-14D6F6B0732F Wed, 27 Feb 2008 10:15:11 -0500 The authors describe a method for comparing actual to expected visit rates at the physician level that controls for patient characteristics, providing a potentially useful measure for performance monitoring, feedback and quality improvement. http://www.longwoods.com/product.php?productid=19572 5B19C87C-2E76-42A7-99B5-324CB55967FD Wed, 27 Feb 2008 10:14:03 -0500 Web 2.0 heralds a breakthrough opportunity for empowering healthcare consumers of all types, and especially for those suffering from different forms of chronic illness. As I show using some data gathered from a popular social networking website MySpace.com this opportunity may be greatest for heavily stigmatized chronic health issues, such as obesity and mental illness. I shall also discuss how hospitals and health regions can benefit from, and contribute to, this fast-growing phenomenon. http://www.longwoods.com/product.php?productid=19506 56B14088-5338-4A1F-90BD-D14205A97647 Fri, 18 Jan 2008 10:04:56 -0500 Saskatchewan's Chronic Disease Management Collaborative is a quality improvement model that brings together healthcare providers to learn about, test and share experiences with improvement ideas in diabetes and coronary artery disease care. This innovative initiative was recently featured in Promising Practices, a monthly series produced by the Canadian Health Services Research Foundation highlighting organizations that have invested their time, energy and resources to try to improve their ability to use research in the delivery of health services. http://www.longwoods.com/product.php?productid=19393&cat=517 9A409535-7002-4D02-A9FA-86DEBA3F50FF Mon, 19 Nov 2007 10:58:56 -0500 Ironically, managers reported high levels of burnout, but good mental and physical health. Middle managers were more empowered and satisfied with their jobs than first-line managers. In both groups, approximately 45% of the variance in job satisfaction and 18-52% of the variance in physical and mental health was explained by empowerment and burnout. Empowered work environments were associated with lower nurse manager burnout and better physical and mental health. The results suggest that creating work environments that provide access to empowerment structures may be a fruitful strategy for creating healthy work environments for nurse managers. http://www.longwoods.com/product.php?productid=17020&cat=355 22597EEE-7C15-4155-B0D0-B826F25F0C6A Mon, 15 Nov 2004 16:23:29 -0400 Increasingly, hospitals are employing systems of performance comparison and "benchmarking" as a method of identifying opportunities for improving their practices. Academic health science centers, with their focus on research, have been particularly active in this regard. In 1995 the Toronto Academic Health Science Council (TAHSC), a joint venture of the University of Toronto and its affiliated teaching hospitals, agreed to focus its research on hospital management practice in the course of developing performance comparisons and suitable benchmark data. Since the achievement of truly comparable data and performance analysis is compromised by significant variations in data reporting, the TAHSC research focused on reducing data-reporting variations among the member hospitals. http://www.longwoods.com/product.php?productid=16753&cat=306 38526A7F-C849-45AF-87AB-1891101201FB Sun, 15 Mar 1998 16:22:48 -0400 This case reports on the implementation of the Clave® needlefree intravenous administration system, its effect on clinical nursing practice (including safety), associated patient benefits and its economic impact at St. Joseph's Health Care (SJHC) in London, Ontario. SJHC consists of five facilities with a combined total of almost 1,900 beds and 5,500 employees. This case also illustrates the benefits of evaluating the results of technology implementation and associated processes to identify opportunities for clinical practice change. http://www.longwoods.com/product.php?productid=17725 0EC85B08-6BC4-43A4-8787-9D9B75A6A5B0 Tue, 21 Aug 2007 16:22:18 -0400 Historically, home healthcare has been carried out by independent organizations that provided limited-scope services in a home-only setting. But as capitation takes hold throughout the country, it is becoming clear for healthcare providers, payers and patients, that home care is often the most beneficial way of providing major portions of patient care. A central challenge remains for IT executives: How to seamlessly integrate a growing number of roaming home care workers into the enterprise's core information processing system? In order to integrate home healthcare personnel into a contemporary IT environment, one must address minimum requirements related to electronic communication: a venue-transparent electronic patient record; real time communication; best practices support; integration of personnel; and mobile computing. http://www.longwoods.com/product.php?productid=16582&cat=306 7345942C-04D2-43C7-B907-F35F62FA27FA Sun, 15 Mar 1998 16:21:39 -0400 Direct-to-consumer advertising is but one example of a process called disintermediation that is directly affecting primary-care physicians and their patients. This paper examines the trends and the actors involved in disintermediation, which threatens the traditional patient-physician relationship. The paper outlines the social forces behind these threats and illustrates the resulting challenges and opportunities. A rationale and strategies are presented to rebuild, maintain and strengthen the patient-physician relationship in an era of growing disintermediation and anticipated advancements in cost-effective office-based information systems. http://www.longwoods.com/product.php?productid=17097&cat=357 71743C0F-1828-4270-A2C8-EA9A48DE7ACF Tue, 15 Mar 2005 16:21:00 -0400 Hear Michael Guerriere's thoughts and analysis of successful and disappointing projects involving IT in healthcare. How are wait times progressing? What have the achievements and challenges been for netCare, OLIS and SSHA among others? What lessons can be learned from diabetes and chronic care management? http://www.longwoods.com/product.php?productid=18843&cat=485 814619B5-7FC5-4CBC-8609-852828D21CF8 Tue, 21 Aug 2007 16:20:21 -0400 As hospitals reorganize to meet the demand for accessible, cost-effective quality healthcare, nursing's active participation as part of the top management team is vital. The purpose of this study was to describe the leadership profiles of four senior nurse executives and determine their congruence with the theoretical perspectives of the stratified systems theory. A multiple case study methodology was employed to develop individual and group leadership profiles through related experiences obtained during an interview, the organization's expectations based on their job descriptions, and a survey of their self-perceptions of how they spent most of their time. The findings indicated that the executives' leadership behavior was consistent with the theory in that they reported more frequent leadership behaviors at the strategic domain, less activity at the organizational domain, and infrequent activity at the production domain. Individual profiles were uniformly consistent with the group profile. http://www.longwoods.com/product.php?productid=16315 E40EBECB-7AD2-4CC9-BCFA-6E848378D16F Sat, 15 Jan 2000 16:19:42 -0400 On February 5, 2003, the Prime Minister and Premiers of seven provinces signed an agreement, the First Ministers' Accord on Health Care Renewal, outlining the direction of public healthcare in Canada in the near future. The Accord addressed several key issues in healthcare, namely prescription drug coverage, home care, diagnostic services, timeliness of care and primary healthcare reform. This paper critiques the home-care initiatives outlined by the First Ministers, on the grounds that they do not speak to issues of access to long-term care or to non-professional home care - services that are deemed critical by the elderly who wish to stay at home and who represent an increasing proportion of the country's population. Furthermore, the Accord does not establish legislative protection or separate funding, both of which are necessary to ensure that home care as a whole receives an adequate share of resources and political attention over the medium and long-term. http://www.longwoods.com/product.php?productid=17232&cat=370 0726326A-92EC-456B-86A2-0AC313FFCDFB Sat, 15 Jan 2005 16:19:04 -0400 The aim of this in-depth, longitudinal, qualitative case study was to understand and explain the dynamics of implementing a pilot project to deliver integrated healthcare for type 2 diabetic patients. Data gathering included in-depth, face-to-face interviews with family physicians, nurses and other healthcare providers, managers and policy makers (n = 25) at various points during the research period, and focus groups (n = 3) with patients. These data were complemented by onsite observations of numerous committee meetings, and analysis of project documentation. Benson's (1975) political economy perspective provided a valuable conceptual framework for tracking the complex dynamics of implementing service integration. Manipulative strategies (continuing medical education, new information technology) did not engage physicians. Of the cooperative strategies attempted (disease management, patient education, community mobilization), only patient education appears to have succeeded: patients acknowledged that project educational activities enabled them to improve self-management of their disease. However, the project's emphasis on patient education effectively increased nurses' bargaining power within the healthcare team, to the detriment of the focus on integrated care. Integrating care is a laborious process that takes time to reach fruition. This one-year pilot project was insufficient for mobilizing health professionals away from fragmented practices toward integrated ones. New resources mostly allowed them to maintain or increase their power positions within the network of care providers. Nevertheless, this initiative raised physicians' awareness and appreciation of the care that other health professionals provided to their patients. http://www.longwoods.com/product.php?productid=18119&cat=437 E551C9AF-0499-46FF-8032-FB9ABED2301A Sat, 15 Apr 2006 16:18:30 -0400 Despite considerable rhetoric to the contrary, nurses still tend to work within institutions (hospitals and long-term-care facilities). However, compared to their numbers in 1993, there were fewer nurses providing direct patient care in Ontario in both the hospital and community sectors, and a higher proportion of older nurses. http://www.longwoods.com/product.php?productid=18116&cat=437 2D1D9E7F-A100-4639-A527-5F3E2F241BEA Sat, 15 Apr 2006 16:17:54 -0400 Laupacis, Anderson and O'Brien's comprehensive diagnosis of the illness affecting the Canadian healthcare system is very insightful. In addition, their call for improving the quality of drug evidence and outcomes is a laudable goal. However, their prognosis of the negative impact on healthcare due to escalating drug costs appears to be rather pessimistic, as they fail to view drugs within an integrated framework. In part, their prescription for the perceived malady is rather impractical. Their recommendation for mandatory head-to-head randomized studies, as a prerequisite for achieving new drug listing in benefit formularies, suffers from many drawbacks. Such studies would be highly time-consuming, extremely costly, and given the fact that the choice of a drug comparator is a "moving target," the end result may not achieve the original intent. http://www.longwoods.com/product.php?productid=16913&cat=340 55E48B75-8A81-407E-ACEE-A479E1824072 Mon, 15 Jul 2002 16:17:22 -0400 Given the increasing incidence of chronic diseases across the world, the search for more effective strategies to prevent and manage them is essential. The use of the Chronic Care Model (CCM) has assisted healthcare teams to demonstrate effective, relevant solutions to this growing challenge. However, the current CCM is geared to clinically oriented systems, and is difficult to use for prevention and health promotion practitioners. To better integrate aspects of prevention and health promotion into the CCM, an enhanced version called the Expanded Chronic Care Model is introduced. This new model includes elements of the population health promotion field so that broadly based prevention efforts, recognition of the social determinants of health, and enhanced community participation can also be part of the work of health system teams as they work with chronic disease issues. http://www.longwoods.com/product.php?productid=16763&cat=328 6CA689F7-BA88-4E95-A120-58AF1B5E5CA4 Sat, 15 Nov 2003 16:16:37 -0400 The Veterans Health Administration is the United States' largest integrated health system. Once disparaged as a bureaucracy providing mediocre care, the Department of Veterans Affairs (VA) reinvented itself during the past decade through a policy shift mandating structural and organizational change, rationalization of resource allocation, explicit measurement and accountability for quality and value, and development of an information infrastructure supporting the needs of patients, clinicians, and administrators.Today, the VA is recognized for leadership in clinical informatics and performance improvement, cares for more patients with proportionally fewer resources, and sets national benchmarks in patient satisfaction and for 18 indicators of quality in disease prevention and treatment. http://www.longwoods.com/product.php?productid=17381&cat=&page=1 142D82C1-2559-44DF-BF54-FF5C4D214D76 Sun, 15 May 2005 16:15:25 -0400 Although boasting may be foreign to our character, we Canadians can be proud of many things. Central among them is our decision to share collectively the financial risks of disease and injury that before medicare were borne alone by those affected, their families or those who would extend them charity. But before we get too puffed up, listen to Tommy Douglas in 1982. "When we began to plan medicare, we pointed out that it would be in two phases. The first phase would be to remove the financial barrier between those giving the service and those receiving it. The second phase would be to reorganize and revamp the delivery system - and, of course, that's the big item. It's the big thing we haven't done yet" (Decter 1994). http://www.longwoods.com/product.php?productid=16692&cat=320 CE79D73A-03C4-4374-B1DF-592187D1868C Sat, 15 Sep 2001 16:14:46 -0400 This study describes a series of interventions linking hospitals, medical staff physicians, long-term care providers and mental health services in the metropolitan area of Syracuse, New York. The objectives of these interventions were to improve patient outcomes and system-wide efficiency. The study demonstrated that these linkages, including system-wide data feedback, contributed to limitation of emergency department overcrowding, reduction of physician lengths of stay, elimination of duplication of medical staff credentialing, as well as access to and efficiency of long-term care and mental health services. http://www.longwoods.com/product.php?productid=18229 627249C2-AC2C-44C2-83DE-2E1AE50CB004 Tue, 21 Aug 2007 16:14:03 -0400 Developing countries face a double burden of disease - communicable and noncommunicable diseases alike, with very few, and often shrinking, resources.While poorer countries will be able to learn about the essential elements of home-based care from the examples of Canada and other industrialized countries, they do need to develop their own systems based upon their economic, social, political and cultural realities. The primary health care system would seem to provide a foundation for the provision of longterm care on a sustainable and cost-effective basis. In contrast to the often-prevailing practice in developed countries, home-based care services could be integrated into the overall health and social system. Functional disability, regardless of disease aetiology or age of the care recipient, as well as the needs of family caregivers would thus become the defining elements of service eligibility. http://www.longwoods.com/product.php?productid=17360&cat=335 D703F8EF-8B47-422A-A7B7-C8F9971DA979 Fri, 15 Sep 2000 16:08:51 -0400 Ontario is implementing a number of steps to address the growing need for home care and continuing care. One of these steps is the establishment of Ontario's network of 43 Community Care Access Centres (CCACs). Responsible for aiding Ontario residents who seek community-based long-term healthcare, CCACs coordinate access to home services such as nursing and homemaking, manage placement to long-term care facilities and provide information and referral services. http://www.longwoods.com/product.php?productid=17359&cat=335 176582D8-4576-4C9E-9E44-1FC4FA161DB5 Fri, 15 Sep 2000 16:08:29 -0400 In the last election, the Liberals promised a national home-care program. Where is it? The Liberal government promised a national home-care program in its last mandate. Canadians are still waiting. This despite the fact that home care and other community-based health services are the foundation and future of our universal healthcare system. http://www.longwoods.com/product.php?productid=17358&cat=335 D5D2E82C-AEA4-42B7-9ED3-7633E49497D2 Fri, 15 Sep 2000 16:07:59 -0400 The arguments and model put forward by MacAdam are laudable, but fall short. The proposal would create a home-care system that is a support system for medical care, thus fulfilling only one of the three functions of home care. The emphasis in the model on expanding professional services addresses the demands for increases in intensive postacute care. However, the support of chronic long-term care and of health promotion and disease prevention would not be strengthened and, indeed, would lead to the already visible demise of traditional chronic long-term care as evident throughout recent health reform. It would ensure that a preventive function is not developed. http://www.longwoods.com/product.php?productid=17357&cat=335 D7FAD9A8-2534-4812-80AE-AD46F193E2A1 Fri, 15 Sep 2000 16:07:32 -0400 This commentary agrees with Dr. MacAdam that the time has come to implement a national home-care program based on principles similar to those that underpin the Canada Health Act. It also agrees with the general thrust of the proposed vision. However, it disputes some of the grounds on which Dr. MacAdam's vision is based and offers alternative perspectives on key aspects of home care. It concludes with a discussion of the issues that will influence the prospects of reaching a federal/provincial consensus on a Canadian home-care program. http://www.longwoods.com/product.php?productid=17356&cat=335 BF563317-F6EA-46F5-AD08-6E825D9FA3BF Fri, 15 Sep 2000 16:07:08 -0400 Caught up in the drop-dead pace of change in the world around us, it often appears that everything in life is uncertain; yet perhaps, in healthcare, nothing is actually changing. Nonetheless, the potential role of home care, which offers the flexibility for us to do different things and respond more effectively to emerging needs of individuals and families, has always been exciting and offers such tremendous promise. There is something quite magical about the relationship with clients in their own homes. Healthcare is all about relationships, and with today's technologies and other enablers that offer incredible opportunity to foster deeper, more meaningful relationships, the potential for home care in this new, evolving world is particularly exhilarating. http://www.longwoods.com/product.php?productid=17355&cat=335 ED5504A2-C127-4216-B7D2-E506FDC846B5 Fri, 15 Sep 2000 16:06:42 -0400 This commentary argues that there are several elements present today to foster the development of the components of a Canadian home care model. The potential and limitations of these elements are discussed. http://www.longwoods.com/product.php?productid=17354&cat=335 CEEF828A-DEED-4D7C-B4E3-C5573084811A Fri, 15 Sep 2000 16:06:12 -0400 While MacAdam proposes a "national approach to home care" the obstacles to this are well known and substantial. They are the likely cost and the limitations of the federal government's role in healthcare. Building on MacAdam's assessment, this paper outlines four problems embedded in the various home-care service delivery models in Canada: the lack of factual client outcome information to support decision-making, the limited client choice of provider, the perverse incentive of fee for service and the bias against the for-profit provider. The paper proposes that the assessment, classification and measurement of outcomes for every recipient of home-care services be standardized using a proven assessment instrument, such as OASIS-B or MDS-HC, by healthcare professionals certified in its use. The resulting information would be captured in a regional database and available for analysis and research. CIHI would be contracted to manage a national database and to fund the training and certification of assessors. The paper proposes a new service delivery and funding model, utilizing standard client outcome information, different roles for regional health authorities and service providers, and a prospective payment mechanism replacing fee for service. A national home care program may be an elusive dream, but that shouldn't stop experimentation, evaluation and improvement. http://www.longwoods.com/product.php?productid=17353&cat=335 9749338F-D10D-4974-AA56-31293A01E709 Fri, 15 Sep 2000 16:05:06 -0400 To maximize the effectiveness of home care in improving or maintaining the health of Canadians, home-care programs must have clear goals, be founded firmly on evidence of effectiveness, form part of an integrated healthcare system and be grounded in constitutional and political reality. Goals should be client-centred and distinguish between curative, supportive and preventive care. Curative and supportive home care can be cost-effective if substitution for more costly institutional services can be achieved, but the cost-effectiveness of preventive home care and comprehensive care for the elderly has not been clearly demonstrated. Integrated delivery systems are a prerequisite for effective substitution of care at home for institutional care. Federal financing dedicated to a homecare program is unnecessary and is a political and constitutional non-starter. Federal leadership for a national home-care approach would be welcome. Canada Health Act protection for access to medically necessary home care is attractive, but such protection for pharmaceuticals is a higher need. Federal support for research and demonstration of new models of care is valuable. http://www.longwoods.com/product.php?productid=17352&cat=335 CFF295F9-CC12-409A-B180-DC9875E6BFBD Fri, 15 Sep 2000 16:04:41 -0400 In her paper, MacAdam refers to future challenges in health human resources for the home-care sector. This paper builds on her comments and discusses conceptual and practical approaches to future planning of health human resources. Necessary national data requirements are identified for this type of planning. The authors point out the limitations of traditional supply-side modelling and describe a new framework linking population health needs to outcomes that builds upon earlier conceptual work in needsbased, utilization-based and effective demand-based models. http://www.longwoods.com/product.php?productid=17351&cat=335 FC9E02BD-D29D-4F9D-A67B-F8D3DBCC8256 Fri, 15 Sep 2000 16:04:19 -0400 Developing and implementing a national approach to home care has been an ongoing and sometimes controversial point of debate between the provinces and the federal government for a few years. We agree that Canada is ready for such a model, but the policy instruments imbedded in the model must be carefully considered. In our commentary we expand on several points made by the lead paper, but focus specifically on the proposed model with respect to the suggested policy instrument recommended for financing the model and some of the key issues surrounding the delivery of home care. It is imperative from our perspective that the current political environment be fully understood to appreciate the context in which the model would be introduced. http://www.longwoods.com/product.php?productid=17350&cat=335 EDE326EA-EE6A-4B17-98AB-C266720B5DB1 Fri, 15 Sep 2000 16:03:37 -0400 Why is home care excluded from the Canada Health Act? In the 1960s, the Hall Commission suggested that home care be covered through medicare. History decided otherwise - only "medically" necessary care was insured. Today, home-care services are provided in conjunction with episodes of hospital care, or are delivered to frail individuals as part of their social and healthcare needs. However, healthcare can no longer be defined simply as a state of absence of disease. Health also includes individuals' physical and mental functional abilities. Coverage for health services should include those services aimed at preserving and maintaining functional abilities. Moreover, access to home care is inequitable in Canada. Financing mechanisms should improve integration of care, not increase barriers between medical, hospital and social care. As home-care services are provided to persons with different needs, financing and organizational mechanisms have to guarantee that resources are distributed most effectively to meet these needs. Finally, home-care delivery should adapt to local, regional and provincial realities. There is no such thing as "one" Canadian home-care model. Already, a number of experiments with home care are being implemented in Canada. It is in the search for innovative service delivery modalities that Canadians will best be served. http://www.longwoods.com/product.php?productid=17349&cat=335 28221316-730F-434A-AA4B-28A3B1EB4033 Fri, 15 Sep 2000 16:02:47 -0400 Although all provinces and the territories offer home-care programs, Canada does not have a national home-care program, nor are public home-care services covered under the principles of the Canada Health Act. As a result, Canadians face varying eligibility, cost, quality and access issues to home-care services. Until recently , policy makers have had poor information upon which to make decisions about the role of home-care programs within the larger health-delivery system. This paper includes a review of the most recent policy relevant information about home care in Canada as well as descriptions of new models of home care in Canada and other countries. Mounting evidence of costeffectiveness, in combination with demographic, health delivery and technological changes, are bringing home care to the forefront of Canadian health policy. Other countries are moving forward to make home care an equitable and viable option within their health delivery systems. Canada could do the same by enacting national home-care legislation in partnership with the provinces. http://www.longwoods.com/product.php?productid=17348&cat=335 44AAEE59-43A2-4FA8-8078-5329C89646D6 Fri, 15 Sep 2000 16:01:44 -0400 When it comes to medicine , surgeons and engineers aren't very different. Together, they can collaborate with the similar goal of turning daunting medical problems for patients into solutions. This desire for collaborative solutions continues to be Dr. Geoff Fernie's primary motivation as a biomedical engineer. As both vice-president of research with the Toronto Rehabilitation Institute and professor in the Department of Surgery at the University of Toronto, Dr. Fernie, who is funded by the Canadian Institutes of Health Research (CIHR), strives to produce inventions that will help those who suffer from problems related to aging, infections, disabilities or immobility. "To this day, the goal is to help people," Dr. Fernie says. "That's what we're here for." http://www.longwoods.com/product.php?productid=18816&cat=481 07AAF495-8102-42B6-8248-271A72B61022 Sun, 15 Apr 2007 15:51:09 -0400 I read, with interest, the paper by Rosser and Kasperski. I was struck by how similar and applicable the problems and issues identified for family physicians are to those pharmacists face today in Canada's health system. There is a need for a coordinated and systematic approach to address infrastructure support for all primary-care providers. In this companion article, I will provide evidence to support the Ontario College of Family Physicians' position on strengthening family physicians' abilities to provide excellent primary care. In addition, I will make a case for support of greater involvement of pharmacists in community- based primary-care teams. http://www.longwoods.com/product.php?productid=17450&cat=332 87D3AD2F-AEA1-4F6F-86EC-5DBD83E072E5 Wed, 15 Dec 1999 15:50:13 -0400 The paper by Rosser and Kasperski represents the positions of the Ontario College of Family Physicians. Their rostering proposal has been taken up by the Ministry of Health and the Ontario Medical Association. My comments will be largely on the ideas as seen in the light of their planned implementation. http://www.longwoods.com/product.php?productid=17228&cat=332 837AAAA0-A2C8-4668-B0B7-C465CAB5F9A8 Wed, 15 Dec 1999 15:49:45 -0400 In "Organizing Primary Care for an Integrated System" Rosser and Kasperski propose changing the way family physicians practice to address deficiencies in the current primary-care delivery system in Canada. These deficiencies include... http://www.longwoods.com/product.php?productid=17449&cat=332 E8D1FC1E-56D9-42FE-9234-A684834F71D8 Wed, 15 Dec 1999 15:49:13 -0400 It is distressing to an observer from south of Canada to read the paper from the Ontario College of Family Physicians (Rosser and Kasperski). It indicates disruption and confusion within an admirable healthcare system - a system with a reputation of getting things right when it comes to family practice and primary care. Apparently, all is not well. http://www.longwoods.com/product.php?productid=17448&cat=332 6414E9FA-6EB7-4257-AB40-7E59E371F5EF Wed, 15 Dec 1999 15:48:38 -0400 I ought to start by giving my credentials for writing this commentary. I have a marked aversion to outsiders with limited first-hand experience telling me about the British National Health Service. This is especially so when their questions and comments raise issues that make me feel uncomfortable. My credentials are all those that I normally abhor. I spent a week in Toronto in May 1999. I visited the medical school and three teaching hospitals. I spoke with many family physicians and some "patients." I interpreted what I heard in the light of my experience and prejudices. Some of the latter will appear in this commentary. http://www.longwoods.com/product.php?productid=17447&cat=332 40A46137-6FCF-4CAE-9BD1-63AD7822E244 Wed, 15 Dec 1999 15:48:14 -0400 s a long-time advocate of primarycare reform and a participant in the present implementation of the Ontario Primary Care Reform (PCR) pilot projects, I am sympathetic to the perspectives of Rosser and Kasperski. The model for reform that they propose has added fuel to the debate on PCR initiatives. However, the future strategic direction for primary care will be determined at the conclusion of the implementation and testing period for the pilot sites and after evaluating models in other provincial jurisdictions. Although the investment of resources over the past four years by government and the profession has clearly been significant, the methodical planning and breadth of consultation and review on many issues may not be apparent to observers. http://www.longwoods.com/product.php?productid=17446&cat=332 B0F121DB-6E73-41B7-B98C-4A073F193C67 Wed, 15 Dec 1999 15:47:48 -0400 The article by Rosser and Kasperski, "Organizing Primary Care for an Integrated System," provides an important stimulus for examining issues surrounding healthcare reform in Canada. As the "Guidelines for Commentary" of HealthcarePapers indicate, healthy debate can foster "constructive change." The Canadian Nurses Association welcomes the opportunity to engage in such a debate and it is within this spirit that we offer a number of challenges, both at a theoretical/conceptual as well as a factual level, to the ideas presented by Rosser and Kasperski. Although there are a number of points in the article that warrant attention, this commentary will address only a selected few. http://www.longwoods.com/product.php?productid=17227&cat=332 FF0716C7-81F5-4B69-A32D-904D4A60D713 Wed, 15 Dec 1999 15:46:37 -0400 Rosser and Kasperski build upon and consolidate several earlier reports to put forward a "bottom-up" model for the integration of health services for Ontario that establishes the family physician as the focal point of entry to the healthcare system. The essential features of this model are as follows: http://www.longwoods.com/product.php?productid=17445&cat=332 52F57940-0572-4B1C-99BC-ED86399834BE Wed, 15 Dec 1999 15:44:30 -0400 This paper proposes a number of changes to the infrastructure that supports the role of family physicians, including family physician accountability for delivering twenty-four-hour, seven-days-per-week services to a defined population of patients. The infrastructure needed to support family physicians as the coordinators of care across the continuum of healthcare services includes family-medicine group practices or practice networks linked by electronic networks. Family medicine is the key to health-system integration. Systems to integrate family medicine with other primary healthcare providers and with secondary- and tertiary-care systems are proposed, as well as quality-improvement systems for family medicine. http://www.longwoods.com/product.php?productid=17444&cat=332 0DBEDD97-33AB-4AD5-8142-7876A13F89F9 Wed, 15 Dec 1999 15:43:33 -0400 In many Canadian rural and urban areas, the role of the family physician within hospitals has gradually diminished over the past 30 years. In Canada, approximately 34.5% of family physicians provide in-hospital care for their patients (College of Family Physicians of Canada 2003). This corresponds with 29% of Ontario respondents (College of Family Physicians of Canada 2003). While the availability of family physicians to meet demands to provide hospital in-patient care is one main issue, choosing a more flexible lifestyle and increasingly busy community practices are also reasons that keep family physicians from this aspect of care. http://www.longwoods.com/product.php?productid=18177&cat=443 1B23FC8B-B9DE-4C8A-A0C8-E3477598312A Mon, 15 May 2006 15:42:38 -0400 Currently, there is no standardized approach in practice for collecting and organizing data and information on health outcomes for most of our healthcare disciplines including nursing, pharmacy, occupational therapy and physiotherapy. For many years, nurse administrators have experienced frustration over the lack of significant data regarding nurses' work that has a direct impact on patient outcomes. This situation has been particularly problematic when justifying budgets or publicly demonstrating how nurses directly affect the health of their patients and clients. At the same time, given the range of personnel who deliver direct care to patients, collecting data related to patient outcomes would allow administrators to guide their allocation of care to other regulated and non-regulated healthcare workers. This significant shift in the use of patient outcomes in the practice setting needs to be integrated into nursing education curricula so that students will be prepared conceptually, technically and practically for the changes that are currently happening. http://www.longwoods.com/product.php?productid=18365&cat=451 607DD275-452E-4C1D-93A0-74D750F1E084 Fri, 15 Sep 2006 15:41:38 -0400 A principal goal in enhancing primary care in Canada is to increase emphasis on health promotion, disease prevention and the management of chronic diseases in the primary care setting. To achieve this goal in Nova Scotia, collaborative practice teams with a nurse practitioner and at least one physician were established, and both alternative funding arrangements for physicians and an information system were implemented. This study reports on the impact of this primary healthcare reform initiative on the quality of process-of-care, self-care and proxy measures for specific health outcomes for patients with diabetes and hypertension. http://www.longwoods.com/product.php?productid=18105 23634AB1-FCDD-4161-B070-3ADA011620CD Wed, 15 Mar 2006 15:39:38 -0400 Home care has risen steadily in recent years to become the most popular of potential new directions in medicare reform. http://www.longwoods.com/product.php?productid=16640&cat=325 E34129F7-8920-470B-A29F-6477A4C1F91E Sun, 15 Dec 2002 15:36:37 -0400 As has been true for other sectors of the health system, policy-makers and service providers in psychiatry have begun to place a greater emphasis on equitable funding, accountability, cost-effectiveness and responsiveness to the complex needs of persons with mental health problems. In Ontario, the move towards case-mix-based funding for acute care, long-term care and chronic care facilities raised an interest in the establishment of similar systems for inpatient psychiatry. What began as a funding-driven policy initiative has resulted in the development of a new comprehensive assessment system for psychiatry designed to support multiple applications to meet the needs of multiple audiences. The aim of this article is to outline the collaborative development process that resulted in the creation of the Resident Assessment Instrument - Mental Health (RAI-MH) and to summarize new research initiatives to be undertaken as part of its ongoing evolution. A detailed technical analysis of reliability and validity is provided elsewhere (Hirdes et al. forthcoming). http://www.longwoods.com/product.php?productid=16756 1AC7BDB0-210D-4A6A-9A03-4B2EC812723F Fri, 15 Dec 2000 15:36:03 -0400 This commentary suggests that the inability to include all components of the continuum of care within most models accounts for the lack of "transformational change" that regionalization has as yet been unable to achieve. To expect that any significant gains will be made in the regionalization process until all aspects of the continuum are under a region's control is unrealistic. The commentary proposes that it is time to review the underlying premises for regionalization and its current emphasis on acute care. http://www.longwoods.com/product.php?productid=16840 FF8F7E99-5FA1-4800-A9B0-2C7B9ED7675A Thu, 15 Jul 2004 15:35:25 -0400 Chronic obstructive pulmonary disease (COPD) is a prevalent condition causing progressive airflow obstruction and deterioration in health-related quality of life (HRQOL) and overall health status. This major community health problem is correlated with significant morbidity, mortality and costs to health care systems globally. Few data report the effectiveness of outreach home nursing intervention programs to help individuals self-manage COPD. This study reviewed the effectiveness of outreach nursing programs for improving lung function, exercise tolerance, HRQOL, mortality and hospitalization outcomes for COPD patients. Although nursing outreach COPD programs for COPD may improve HRQOL and related outcomes for those with mild to moderate disease, the impact of such programs on hospitalization rates has not been adequately examined. http://www.longwoods.com/product.php?productid=17986 22347307-960E-43E3-A96B-66B1D1EF52E6 Tue, 15 Jun 2004 15:34:17 -0400 There was a time when the major concern about patient privacy was the occasional news reports of medical records found in backyards, back alleys and favourite watering holes along with our tax returns and excess body parts and used needles from the local hospital. Apart from the usual exclamations of shock and dismay, most people seemed to regard these incidents as lapses in the local institution rather than as symptoms of systemic problems with the privacy of their personal medical information. http://www.longwoods.com/product.php?productid=16671 1B5E319B-6F18-4A3E-8F15-382AF88F0C0E Sat, 15 Jun 2002 15:33:08 -0400 In the May 4, 1999 issue of the Medical Post I hypothesized that the prevailing debate around primary care reform (PCR) in Ontario raised two questions: Is PCR part of an overall strategy to "bureaucratize" medicine by the bureaucratic/pseudo-academic conspiracy that manages health? Or is PCR a Machiavellian plot by the OMA to preserve the status quo for yet another three years? http://www.longwoods.com/product.php?productid=16523&cat=321 C3C7C3FD-70FE-474F-8E13-06F9DADCBAC0 Sat, 15 Dec 2001 15:31:58 -0400 The Province-Wide Nursing Project (PWNP) was designed to remove some of the structural barriers that can impede the ability of nurses in selected health care settings to assess, implement and evaluate best nursing practice. Literature on capacity building and research utilization suggests that the organization is the most important factor in promoting best nursing practice. Therefore, managers and nursing leaders need to encourage the creation of optimum work environments. A survey undertaken by the PWNP Research Centre team assessed the extent to which the 23 agencies in the 4 Participating Complexes provided supportive environments for evidence-based practice. The Characteristics of Agencies in Participating Complexes: Demographics and Resources questionnaire investigated the resources available to help nurses improve their standards of practice in agencies participating in the project. Larger agencies, especially those associated with academic centres, had considerably more resources than agencies in smaller towns. Participation in the Province-Wide Nursing Project enabled agencies to develop strategies to improve the use of evidence in nursing practice. http://www.longwoods.com/product.php?productid=16300 2EBDE99B-F8F9-4E0E-B6E6-CC5A1B17030F Sat, 15 Jan 2000 15:31:22 -0400 A number of readers have told me that the long-standing debate over home care is about to move out of the boardrooms and into the mainstream in this country. I think they are probably right. For several years, home care has been positioned as one of the solutions to hospital cuts and overcrowding. The theory goes that if we could move recovering patients out of hospitals quicker, then we could reduce the amount of resources needed in hospitals, which are a reputedly more expensive type of care. http://www.longwoods.com/product.php?productid=16778&cat=315 4FDF4A7A-F716-472D-BF17-5FB826D9D5A1 Thu, 15 Jun 2000 15:29:47 -0400 The arguments and model put forward by MacAdam are laudable, but fall short. The proposal would create a home-care system that is a support system for medical care, thus fulfilling only one of the three functions of home care. The emphasis in the model on expanding professional services addresses the demands for increases in intensive postacute care. However, the support of chronic long-term care and of health promotion and disease prevention would not be strengthened and, indeed, would lead to the already visible demise of traditional chronic long-term care as evident throughout recent health reform. It would ensure that a preventive function is not developed. http://www.longwoods.com/product.php?productid=17357&cat=335 0338B6D1-3C95-43AC-B9C7-80554555EAA1 Fri, 15 Sep 2000 15:28:59 -0400 Capital Health in Edmonton, Alberta, implemented a system-wide chronic disease management model to support people with chronic disease and their primary care physicians. Groups of family physicians, in partnership with the health region, developed primary care networks to provide services that are customized to meet the priorities of the local community. Management of chronic disease is a cornerstone service, and diabetes management is the most fully developed program. Key to its success are standardized protocols, consistent follow-up and patient education by trained primary care nurses. This model will be used as a template for the management of other chronic diseases. http://www.longwoods.com/product.php?productid=18927 CA6951A3-4EC0-46DA-8EFE-4EC3961EFFDC Tue, 15 May 2007 15:25:49 -0400 Given the increasing incidence of chronic diseases across the world, the search for more effective strategies to prevent and manage them is essential. The use of the Chronic Care Model (CCM) has assisted healthcare teams to demonstrate effective, relevant solutions to this growing challenge. However, the current CCM is geared to clinically oriented systems, and is difficult to use for prevention and health promotion practitioners. To better integrate aspects of prevention and health promotion into the CCM, an enhanced version called the Expanded Chronic Care Model is introduced. This new model includes elements of the population health promotion field so that broadly based prevention efforts, recognition of the social determinants of health, and enhanced community participation can also be part of the work of health system teams as they work with chronic disease issues. http://www.longwoods.com/product.php?productid=16763 9D82AB13-09D3-4071-A76D-10399A71E8C0 Sat, 15 Nov 2003 15:25:20 -0400 In recent years, governments have grappled with the increasing demands placed on health care systems by shifting care from institutions to the community, particularly for patients with chronic conditions. The author argues that this process of rationing results in the social exclusion of chronic care users. She also finds that this rationing is one aspect of a larger trend towards understanding need in exclusively medical -- as opposed to broader social -- terms. This trend is a result of the pre-eminent position given to the medical profession in both the determination of need and the funding of care based on clical rather than social needs. Government's emphasis on universality of care, as defined by medical need, risks exacerbating the exclusion of those with social care needs. http://www.longwoods.com/product.php?productid=17979 D36FE532-CD8E-461F-A226-35D864DD3493 Sun, 15 Feb 2004 15:23:54 -0400 Researchers, policy makers and healthcare providers agree that frailty has an important impact on the affected individuals, their families - particularly those involved in caregiving - and society. However, frailty remains an enigmatic and controversial concept (Hogan et al. 2003). The Canadian Initiative on Frailty and Aging (CIFA) was initiated with the overall goals of furthering our understanding of the causes, trajectory and implications of frailty and improving the lives of older persons at risk of frailty by disseminating knowledge on its prevention, detection and treatment, as well as the cost-effective organization of services (Bergman 2003). As a first step, CIFA's multidisciplinary team of researchers collated, critically reviewed and synthesized current evidence and identified gaps in existing research on frailty across various fields. The objective of this article is to present the current research on key policy issues related to the frail elderly. http://www.longwoods.com/product.php?productid=18923 C6591529-EC38-4DAD-8C66-CB2AD6C739D0 Tue, 15 May 2007 15:22:39 -0400 The quality gap in the management of chronic disease is an issue which must be addressed if we are to achieve sustainability of our health system and optimal health outcomes for Canadians. The delivery of quality care needs to be a fundamental expectation of providers, professional regulators, institutional leaders and senior government leaders. Success in the arena of quality improvement comes from clarity of accountability, "obsessive" tracking and action on key performance indicators, and results-based teamwork. Strong leadership, identification of shared priorities across the country, full transparency, and an engaged public are all key to moving ahead in this critical area of Canadian healthcare. http://www.longwoods.com/product.php?productid=19000&cat=495 9C90B8D8-FCBF-4679-9722-1F7C6B2F68ED Fri, 15 Jun 2007 15:20:44 -0400 In this commentary, we offer evidence about the burden of chronic conditions and use diabetes as a case study to reveal the gap between recommended and actual care in Canada. What we found through our research is cause for concern - namely, that the care that Canadians with diabetes receive is simply not good enough (an inconvenient truth) and that the country has tremendous untapped potential to prevent chronic illness and improve the quality of care (a convenient truth). Our work and the work of others help Canadians understand the benefits that will accrue to them from investments to close the gap between what we know and what we do. http://www.longwoods.com/product.php?productid=18999&cat=495&page=1 54BB54AE-4DC3-4FED-BBAB-A01400236C4E Fri, 15 Jun 2007 15:20:23 -0400 The authors of the lead essay present a compelling case for the development and implementation of a national strategy on chronic disease prevention and management (CDPM). The literature demonstrates that the Chronic Care Model can improve quality and reduce costs. Substantial evidence supports the role of health information technologies such as electronic health records (EHRs) in achieving these goals. http://www.longwoods.com/product.php?productid=18997&cat=495 8B36AB68-ED07-4942-9AEF-498A1B008955 Fri, 15 Jun 2007 15:20:02 -0400 Improving the health of individuals and populations while assuring the sustainability of modern healthcare systems requires a greater commitment to chronic disease prevention and management. In Canada, national challenges in the management of health care systems, such as prolonged wait times, have benefited from targeted federal investment, with provincial and territorial collaboration in the development and implementation of local strategies. The lead paper "An Inconvenient Truth: A Sustainable Healthcare System Requires Chronic Disease Prevention and Management Transformation," makes a sound argument for a similar investment toward the epidemic of chronic disease. Any strategy that might emerge from such a federal commitment ought to recognize two fundamentally important issues. First, as chronic disease prevention and management activities are largely community-based (rather than hospital or facility-based), Canada has an opportunity to move beyond a potentially disparate collection of provincial and territorial approaches to a truly national strategy. Second, and more important, effective chronic disease prevention and management will only be achievable if we reframe the challenge as a societal issue, not simply a health system concern. This reframing exercise might benefit from a greater understanding of how societal responses to other crises, such as global warming, have been triggered or accelerated. http://www.longwoods.com/product.php?productid=18996&cat=495 B0307A96-FD3A-4630-8F9F-8CEF0B6005FB Fri, 15 Jun 2007 15:19:34 -0400 This response to the essay is a "view from the trenches" by two doctors who have worked over 23 years at the Group Health Centre in Sault Ste. Marie, Ontario. We would agree wholeheartedly that reducing wait times for selected procedures will not transform our health system, although they are a start that does provide improved quality of life for a relatively small number of people. We have struggled with the care gap between known best practices and the reality of care provided, from the perspectives of both prevention and chronic disease management. This has resulted in an acute awareness of the need for an across-the-system, "bottom-up" approach to the prevention of disease and management of healthcare. Limited resources must be carefully leveraged in innovative ways if we are to eliminate this care gap, decrease morbidity and minimize expensive "rescue" procedures that make our system increasingly unaffordable. http://www.longwoods.com/product.php?productid=18993&cat=495 6E2FEB0A-AE33-4EB1-9BE6-3E945CD2B6DE Fri, 15 Jun 2007 15:16:44 -0400 Morgan, Zamora and Hindmarsh make a compelling case for a national strategy on chronic disease prevention and management. The truths raised in the lead paper are not particularly inconvenient, but they do raise a number of uncomfortable questions: (1) Why are physicians not taking a more responsible and active role to prevent and manage chronic diseases on behalf of their patients? (Physicians must recognize that it is their professional responsibility and their job to provide their patients with the appropriate level of care for chronic conditions.) (2) Why are non-physician healthcare providers not playing a larger role to prevent and manage chronic diseases? (3) Why is there a greater focus on managing chronic diseases than on preventing or delaying them from happening? (4) Have we forgotten the profound impact of the social determinants of health on illness, life expectancy and death? http://www.longwoods.com/product.php?productid=18994&cat=495 A5F59499-EFCD-4CD8-B42B-DEA430E819B8 Fri, 15 Jun 2007 15:15:54 -0400 Initiatives aimed at reducing wait times for surgical and diagnostic procedures and comprehensive chronic disease management programs focus, respectively, on the supply and demand aspects of access to healthcare. Addressing either in isolation can have a salutary health effect for segments of the population and produce system improvement. Approaching healthcare access issues even more broadly, in the context of population health and with a patient-centred perspective, carries the promise of sustainability, the potential for superior health outcomes across a continuum of patient care and the possibility of enhanced system competency through true integration of multiple sectors. A model for comprehensive access to health services includes a plan for a network of primary care providers, appropriate capacity and flow efficiency for the provision of unplanned (emergency) services, operationalization of wait times initiatives to sustain planned services (most surgeries and diagnostic procedures) and a strategy for decreasing demand for care by engaging primary and community care capabilities and a robust chronic disease management strategy. http://www.longwoods.com/product.php?productid=18995&cat=495 6845B7EA-DC4C-4E6F-A2FA-BBC1D030C71E Fri, 15 Jun 2007 15:13:29 -0400 Canada's initial success at shortening wait times will not transform our healthcare system unless it is matched with equal success in the prevention and management of chronic diseases. A growing body of evidence highlights the significant gap between recommended care and actual care received for those at risk for or living with chronic illnesses. This quality gap not only results in significant preventable morbidity and mortality but also lengthens wait times for healthcare services and threatens the sustainability of our healthcare system. http://www.longwoods.com/product.php?productid=18992&cat=495 C32EDBE9-2F42-4C59-8214-674F5D6F14E2 Fri, 15 Jun 2007 15:12:32 -0400 Morgan and colleagues put forth a call to action for the transformation of the Canadian healthcare system through the adoption of a national chronic disease prevention and management (CDPM) strategy. They offer examples of best practices and national solutions including investment in clinical information technologies to help support improved care and outcomes. Although we acknowledge that the authors propose CDPM solutions that are headed in the right direction, more rapid deployment of solutions that harness the potential of advanced collaborative technologies is required. We provide examples of how technologies that exist today can help to accelerate the achievement of some key CDPM objectives. http://www.longwoods.com/product.php?productid=18998&cat=495 A8A46FE4-9DB7-45E9-AD7F-D00B708EB99B Fri, 15 Jun 2007 15:09:17 -0400 Given the increasing incidence of chronic diseases across the world, the search for more effective strategies to prevent and manage them is essential. The use of the Chronic Care Model (CCM) has assisted healthcare teams to demonstrate effective, relevant solutions to this growing challenge. However, the current CCM is geared to clinically oriented systems, and is difficult to use for prevention and health promotion practitioners. To better integrate aspects of prevention and health promotion into the CCM, an enhanced version called the Expanded Chronic Care Model is introduced. This new model includes elements of the population health promotion field so that broadly based prevention efforts, recognition of the social determinants of health, and enhanced community participation can also be part of the work of health system teams as they work with chronic disease issues. http://www.longwoods.com/product.php?productid=16763 7469A4DA-800E-456E-A021-06D312F63571 Sat, 15 Nov 2003 10:55:50 -0400