June 14, 2011
This article presents some of the Canadian Health Services Research Foundation (CHSRF) findings from the 2010 roundtable series Better with Age: Health Systems Planning for the Aging Population. The series looks at potential issues in the providence of care to the elderly due to expansion of the aged population in Canada. Medical practitioners, policy-makers, healthcare executives, and Canadian citizens all came for the suggest solutions to issues in the deliverance of care to individuals with age-based chronic conditions (i.e. diabetes, dementia, etc.). Common themes found among the suggested solutions include the following:
- integrating social and health services in order to maximize the efficacy of care;
- providing greater support to all types of caregivers;
- and, creating single-source funding in order to remove barriers to system improvement.
Posted in Journal Articles, READ Portal | Tagged with Canada, Health services for the aged, Policy | No Comments
June 8, 2011
“Systematic reviews have the potential to inform decisions made by health policymakers and managers, yet little is known about the impact of interventions to increase the use of systematic reviews by these groups in decision making.
We systematically reviewed the evidence on the impact of interventions for seeking, appraising, and applying evidence from systematic reviews in decision making by health policymakers or managers. Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment Database, and LISA were searched from the earliest date available until April 2010. Two independent reviewers selected studies for inclusion if the intervention intended to increase seeking, appraising, or applying evidence from systematic reviews by a health policymaker or manager. Minimum inclusion criteria were a description of the study population and availability of extractable data.
11,297 titles and abstracts were reviewed, leading to retrieval of 37 full-text articles for assessment; four of these articles met all inclusion criteria. Three articles described one study where five systematic reviews were mailed to public health officials and followed up with surveys at three months and two years. The articles reported from 23% to 63% of respondents declaring they had used systematic reviews in policymaking decisions. One randomised trial indicated that tailored messages combined with access to a registry of systematic reviews had a significant effect on policies made in the area of healthy body weight promotion in health departments.
The limited empirical data renders the strength of evidence weak for the effectiveness and the types of interventions that encourage health policymakers and managers to use systematic reviews in decision making. “
Posted in Journal Articles, READ Portal | Tagged with Decision making, Evidence-based, Policy | No Comments
June 3, 2011
“In 2008, the Health Council of Canada released Rekindling Reform: Health Care Renewal in Canada, 2003–2008, a report on the progress made since First Ministers’ groundbreaking attempts to renew the health care system: the 2003 First Ministers’ Accord on Health Care Renewal, and the 2004 10-Year Plan to Strengthen Health Care (commonly referred to as the health accords)…
Three years after the release of Rekindling Reform, the Health Council of Canada offers this report which, along with subsequent annual reports, will assess progress made on selected accord commitments. This year, we are reporting on wait times, pharmaceuticals management, electronic health records, teletriage, and health innovation. Each section summarizes what the accords say, what we said in Rekindling Reform, and where things stand today (which we have gathered from public sources; through feedback from federal, provincial, and territorial health officials; and from interviews with key stakeholders in the Canadian health care system).
To properly assess progress, it is important to look at what governments have reported to their residents to see whether targets were set for reaching the goals expressed in the accords. Where jurisdictions have set targets for their commitments, we used them to assess progress. Some commitments, such as wait times, have well-developed measures to gauge progress, while others require a more narrative approach. Where we can, we describe provincial and territorial strategies for addressing challenges and bringing about renewal.”
Posted in 2014 Health Accord, READ Portal, Reports & Papers | Tagged with Access to care, Canada, Health care reform, Indicators, Policy | No Comments
May 16, 2011
“One of the key challenges for all governments is how to make the best use of evidence in both policy formation and policy evaluation. The challenges are multiple: to identify what research and knowledge is needed; to identify appropriate sources of that knowledge; to ascertain the validity, quality and relevance of the knowledge obtained; and to understand how that knowledge informs a range of potential policy options. As science has become more complex and impacts on every aspect of our lives, offering solutions to many of the problems the world confronts, these issues become more urgent. Yet science alone does not and should not make policy — it provides a basis of information on which other dimensions, including societal values, public opinion, affordability and diplomatic considerations, must be added while also accommodating the political process. But policy made in the absence of information and science-based evidence can only be made on the basis of dogma, and is less likely to serve the country well.”
Posted in READ Portal, Reports & Papers | Tagged with Decision making, Evidence-based, Policy | No Comments
May 2, 2011
Klein, S., & McCarthy, D. (2011). Sentara Healthcare: Making Patient Safety an Enduring Organizational Value. The Commonweatlh Fund. http://www.commonwealthfund.org/Content/Publications/Case-Studies/2011/Mar/Sentara-Healthcare.aspx. Sentara Healthcare, an integrated health care delivery system serving parts of Virginia and North Carolina, has developed a systematic program to foster a culture of safety throughout its member hospitals, with the aim of reducing the […]
Posted in Journal Articles, READ Portal | Tagged with Benchmarking, Efficiency, Policy, Quality assessment, Quality control, Quality improvement, Safety | No Comments
April 26, 2011
“Variations in health care in the NHS are a persistent and ubiquitous problem. But which variations are acceptable or warranted – for example, variations driven by clinical need and informed patient choice – and which are not? The important question is how to promote ‘good’ variation and minimise ‘bad’ variation.
Variations in health care: The good, the bad and the inexplicable explores the possible causes of variation, shows the different ways in which variations can be measured, and analyses variations by PCT in rates of elective hospital admissions for selected procedures.
The causes of variation are complex and inter-related – they may be affected by, for example, differences in geographical patterns of illness, differences in clinicians’ behaviour, the effects of incentives in the financing of health care. These causes are mapped and discussed.”
Posted in Journal Articles, READ Portal | Tagged with Decision making, Policy, Program evaluation, Quality assessment, Quality control, Quality improvement, Safety | No Comments
April 25, 2011
“Legislation is one of the most powerful weapons for improving population health and is often used by policy and decision makers. Little research exists to guide them as to whether legislation is feasible and/or will succeed. We aimed to produce a coherent and transferable evidence based framework of threats to legislative interventions to assist the decision making process and to test this through the ‘case study’ of legislation to ban smoking in cars carrying children.”
Posted in Journal Articles, READ Portal | Tagged with Decision making, Evidence-based, Policy, Risk assessment | No Comments
April 19, 2011
Public health interest and action on health determinants to reduce health inequities is reflected throughout public health’s history including major public health concepts and reports of recent decades (e.g., Ottawa Charter, Reports on Health of Canadians, population health approach, etc.). Explicit expectations for action on health determinants are increasingly embedded within defining parameters of practice such as core public health program and accreditation standards.
Despite public health’s more distant and recent history, public health action on broader health determinants is not widespread and may even be viewed as ‘new’. Either the application of foundational concepts was never universally institutionalized throughout public health or enough time has passed and pressures exerted upon the public health sector that they have been lost. Even within early adopter organizations, action on determinants of health is still at a relatively early stage of implementation versus having been institutionalized throughout. A number of pervasive challenges are barriers to more widespread action. These include: the lack of clarity regarding what public health should or could do; a limited evidence base; preoccupation with behaviour and lifestyle approaches; bureaucratic organizational characteristics; limitations in organizational capacity; the need for leadership; more effective communication; and supportive political environments.
There are also a number of opportunities for achieving success. First, there is the past experience of successively addressing major society-wide challenges (e.g., sanitarians, tobacco control). Increasing evidence to informaction will result from the Institute for Population and Public Health’s (IPPH-CIHR) strategic focus on health equity–related research. Several public health organizations are taking action on health determinants and will thereby add to existing knowledge (i.e., ‘learn by doing’). As evidenced by the interest in this environmental scan, there is considerable and widespread interest in action on health determinants within the public health community. There is also evidence of interest from many sectors across society.
Posted in READ Portal, Reports & Papers | Tagged with Canada, Policy, Public health | No Comments
April 11, 2011
Canadian governments are spending more on healthcare than ever. Driven by technological innovation, population aging, inflation and other factors, public healthcare expenditures are forecast to continue to increase, causing concern about the sustainability of Canada’s publicly funded systems. The hospital sector accounts for over 28% of total healthcare expenditures in Canada. Although this share has fallen considerably over the past few decades, hospitals continue to represent the largest single component of healthcare expenditures. Hospital expenditures are projected to exceed $55 billion in 2010.
Evidence suggests that provinces differ in terms of healthcare spending efficiency, which implies that there should be an opportunity for improvement. An often-cited source of inefficiency in the Canadian hospital sector is the reliance on ‘global budgets’ as the primary source of hospital funding. Global budgets can perpetuate inefficient care because they offer little incentive to reduce costs or foster innovation.
Based on a paper commissioned by CHSRF, this brief provides a summary of the available evidence on promising hospital funding options and their impact on the following goals: timely and equitable access, optimal volume of care, quality, efficiency and constraining future cost increases.
Posted in READ Portal, Reports & Papers | Tagged with Canada, Economics, Efficiency, Funding, Policy | No Comments
March 31, 2011
“Key messages
Canada’s publicly funded healthcare system is facing increasing cost control pressures. Hospitals alone represent a substantial burden on provincial health budgets, accounting for 28% of total costs. Presently, in the Canadian system, the primary source of funding for hospitals is through a global budget. Under this model, a fixed (global) amount of funding is distributed to each hospital to pay for all hospital-based services for a fixed period of time (commonly one year). Global budgets:
- Are based on historical spending, inflation, negotiations and politics in many provinces, rather than on the type and volume of services provided.
- Constrain hospital spending growth and create budgetary predictability; however, its consequences may be decreased services and increases in waiting times.
- Do not provide incentives to improve access, quality or efficiency of hospital care.
Funding hospitals on the basis of the type and volume of services they provide has become the international norm. Known as activity-based funding (ABF), these systems have been systematically supplementing global budgets in public and private insurance-based health systems around the world. ABF:
- Provides powerful financial incentives to stimulate productivity and efficiency: efficient hospitals retain the difference between the payment amount and the hospital’s actual cost of production.
- Is associated with higher volumes of hospital care, shorter lengths of stay, and yet has not been linked to poorer quality of care.
- Is linked to higher overall spending, due to higher volumes of patients being treated, and evidence of lower cost per admission is mixed.
Combining properties of ABF and global budgets may optimize the strengths of both global budgets and ABF. Many countries that have ABF to fund their hospital systems utilize a blend of global budgets to control spending, while instituting an ABF mechanism to create incentives for hospitals to provide timely and equitable access, appropriate volume of care, and efficient care.
In the Canadian context, recommendations are:
- Adopt population-based funding at the regional level to reduce historical funding inequities by recognizing differences in need across populations, regions and over time.
- Blend ABF and global budgets to create incentives for hospitals to improve hospital efficiency and access.
Posted in READ Portal, Reports & Papers | Tagged with Canada, Economics, Funding, Health care costs, Health care reform, Policy | No Comments
