Better Care: An Analysis of Nursing and Healthcare System Outcomes – Canadian Health Services Research Foundation – 18 June 2012

Posted on June 27, 2012. Filed under: Chronic Disease Mgmt, Health Mgmt Policy Planning, Multidisciplinary Care | Tags: , , |

Better Care: An Analysis of Nursing and Healthcare System Outcomes – Canadian Health Services Research Foundation – 18 June 2012

Gina Browne, et al

“Key messages

Problems arise when circumstances in the world change and conventional wisdom does not.

The present federally funded Canadian healthcare system has been driven principally by insured physicians and hospitals providing acute and episodic care that is a poor match to the changing  demographics of persons with chronic disease living longer. The current health system consumes nearly one-half of provincial budgets.

There are solutions.

Recent analysis of 2005 expenditures by member countries of the Organisation for Economic Co-operation and Development on health and social services has empirically demonstrated that, after adjusting for overall gross domestic product per capita, it is the ratio of social service expenditures to health service expenditures that is better associated with improved outcomes in key health indicators and not the amount spent on health services.

Models of proactive, targeted nurse led care that focus on preventive patient self-management for people with chronic disease are either more effective and equally or less costly, or are equally effective and less costly than the usual model of care.

Additional key components of more effective and efficient healthcare models involve community based, nurse led models of care with an interdisciplinary team that includes the primary care physician. Such complex intervention requires specially trained or advanced practice nurses who supplement the care provided by physicians and other healthcare professionals. The proactive, comprehensive, coordinated model of community care is patient and family centered, targeted at community-dwelling individuals with complex chronic conditions and social circumstances.

Telemonitoring offers added effectiveness and efficiencies to healthcare, especially for remote populations.

The monitoring, evaluation and performance measurement system for the provision of healthcare should build on and link to pan-Canadian efforts already under way, such as the Longitudinal Health and Administrative Data Initiative.

Nurse-led models of care can be financed by costs averted from hospitals and emergency departments to home or community care. For example, after managing the current hospital caseload of patients awaiting alternative levels of care, the number of hospital beds could be reduced to free up funds for this reallocation of funding.

In Ontario alone, representing 37% of the Canadian population, independent reports estimate that millions of dollars could be saved in direct healthcare costs within one year by:

having nurses provide leading practices in home wound care
integrating nurse-led models of care to reduce high hospital readmissions by 10% for those with chronic conditions
providing 25% of palliative care in the home as opposed to in acute hospital settings
providing community care for patients in hospital designated as needing an alternative
providing proactive community care and patient self-management for those with congestive heart failure and other chronic conditions

Getting from problems to solutions is possible.”

… continues on the site

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Better Value: An analysis of the impact of current healthcare system funding and financing models and the value of health and healthcare in Canada – Canadian Health Services Research Foundation – 18 June 2012

Posted on June 27, 2012. Filed under: Health Economics | Tags: , , , , |

Better Value: An analysis of the impact of current healthcare system funding and financing models and the value of health and healthcare in Canada – Canadian Health Services Research Foundation – 18 June 2012

Stuart N. Soroka

“Key Messages

Discussions of healthcare reform must acknowledge the following context: on the one hand, public opinion data suggest that Canadians are increasingly concerned about the future viability of public healthcare; on the other hand, Canadians remain highly supportive of universal healthcare in principle, and they remain largely pleased with their own interactions with the system.

There has been a striking increase in public spending on healthcare over the last 10-15 years. Specifically, controlling for inflation, per capita spending on healthcare in Canada was more than 50% higher in 2010 than in 1996.

This investment in healthcare has positive consequences where public assessments are concerned. Increased healthcare expenditures over the past decade appear to have made a difference: Canadians’ assessments of the current system have improved alongside increased expenditures.

Cross-provincial differences in the relationship between various measures of healthcare policy outcomes provide a valuable source of evidence on “value” in healthcare, and results confirm that value is not simply about spending more. For instance, the relationship between spending on physicians and the number of doctors per capita or wait times, or between hospital spending and the nursing workforce, clearly varies across provinces. In some cases increased spending appears to lead to better health policy outcomes; in other cases the relationship is much less clear.

The relationship between increased spending and improved public assessments also appears to vary across spending domains. Specifically, investments in hospitals, in drugs and in public health are more reliably linked to improved public assessments of the system, while spending in other healthcare domains is not clearly associated with improved public assessments.

Capturing “value” in healthcare is possible, then. But at present the required data – including data on key healthcare indicators and public attitudes on healthcare – are only intermittently available. A stronger commitment to monitor system outcomes should accompany a renewed investment in the Canadian healthcare system.”

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Better Health: An analysis of public policy and programming focusing on the determinants of health and health outcomes that are effective in achieving the healthiest populations – Canadian Health Services Research Foundation – 18 June 2012

Posted on June 27, 2012. Filed under: Health Status, Public Hlth & Hlth Promotion | Tags: , , , |

Better Health: An analysis of public policy and programming focusing on the determinants of health and health outcomes that are effective in achieving the healthiest populations – Canadian Health Services Research Foundation – 18 June 2012

Carles Muntaner, et al.

“Key Messages

Although major health inequalities exist in Canada, minimal action has been taken by municipal, provincial/territorial and federal levels of governments to narrow health inequalities through the social determinants of health (SDOH) and public policy.

Income, housing, food insecurity and social exclusion are four major social determinants in generating and reproducing health inequalities over the life course (childhood, adulthood and the elderly stage).

Low-income individuals and families have significantly higher rates of mortality, morbidity and healthcare use as compared with middle- and high-income groups. Health inequalities between the richest 20% and the poorest 20% have decreased from 1971 to 1996 in Canada; however, continued monitoring is needed given that income inequality has increased over the past decade.

Food insecurity and unstable housing are associated with poor health and, in turn, mediate the link between income and health (hunger and unstable housing affect health and result from low income). Mortality rates among homeless and marginally housed individuals were much higher than expected on the basis of low income alone.

Social exclusion is a powerful determinant of health inequalities; however, its effects are dependent upon which groups are compared. The health consequences of social exclusion are most unequal between Aboriginal and non-Aboriginal groups. Immigrant health favours recent arrivals over long-term residents. Compared with non-minority ethnic groups, minority racial/ethnic groups are more likely to experience social and health disadvantages. However, no clear association exists for health inequalities between minority racial/ethnic groups.

Taking action on SDOH to narrow health inequalities offers new opportunities for the nursing profession to expand its role to include:

… continues on the site

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Opportunities to Promote Efficiency in Hospital Decision-Making through the Use of Health Technology Assessment – Canadian Health Services Research Foundation – 13 December 2011

Posted on January 17, 2012. Filed under: Health Technology Assessment | Tags: |

Opportunities to Promote Efficiency in Hospital Decision-Making through the Use of Health Technology Assessment – Canadian Health Services Research Foundation – 13 December 2011

by Gagnon, Marie-Pierre

“Key messages
■Health technology assessment (HTA) is a multidisciplinary area of applied research that produces high quality information about health technologies—drugs, medical technologies and health interventions. The HTA produces recommendations on whether a health technology should be considered, funded and adopted into practice. The goal is to use the research and recommendations from the HTA to inform decisions that will improve quality and cost-effectiveness of healthcare.
■In Canada, there are several well-established agencies at the national and provincial levels that successfully perform HTA. More and more, however, HTA units are being implemented in a local/ hospital-based setting, based on a growing awareness that the local context needs to be taken into account when assessing health technologies.
■Four different models for performing local/hospital-based HTA have been identified and are currently in use world-wide: the ambassador model; mini-HTA; internal committee; and HTA unit. Each has its own strengths and weaknesses. There is insufficient evidence available to adequately assess which of these models would be the best for Canadian hospitals.
■Research shows that local/hospital-based HTA may influence decision-making. There are reports from isolated experiences related to local/hospital-based HTA on hospital decisions and budgets, as well as positive perceptions from managers and clinicians.
■It is difficult to evaluate the overall impacts of HTA on the various levels of healthcare delivery, largely because most hospital-based HTA experiences are recent and there is a paucity of data. Further research is necessary to explore the conditions under which local/hospital-based HTA results and recommendations can have an impact on hospital policies, clinical decisions and quality of patient care.
■The potential exists to share expertise and methodologies between local/hospital-based HTA units. However, there are challenges in directly transferring research knowledge from one organization to another, given the specificity of the context from hospital to hospital.”

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Canadian Primary Healthcare Policy: The Evolving Status of Reform – Canadian Health Services Research Foundation – 16 January 2012

Posted on January 17, 2012. Filed under: Primary Hlth Care | Tags: |

Canadian Primary Healthcare Policy: The Evolving Status of Reform – Canadian Health Services Research Foundation – 16 January 2012

by  Mable, Ann L.; Marriott, John

“The key findings for decision-makers on the current state of Canadian primary healthcare (PHC) policies, and the perceptions thereof, offer insights for renewed direction and action.

■All jurisdictions have maintained some focus on PHC policy. Although the extent and complexity of PHC application varies, the glass is half-full, not half-empty.
■The combined information that can be found about PHC at the federal, provincial and territorial levels provides a foundation of PHC policy direction that could be built upon for a more cohesive PHC strategy across Canada.
■The many links between current PHC activity and work done under prior national initiatives confirm the continuity and legitimacy of direction that, in turn, strengthen the foundations for current PHC reform.
■The system would benefit from renewal of an overarching framework for PHC reform across Canada to provide guidance and a reference point for aligning with principles and objectives and understanding progress.
■Different PHC delivery models, elements and capacity building—many showing considerable innovation—have emerged in jurisdictions across Canada. Their successes should be showcased and problems addressed from a high level to recognize good work and relieve pressures on the ground.
■Given the diverse activity under way and issues of clarity about and between primary healthcare and primary care, there is a perception by key informants of a lack of coherence in reform across Canada.
■Continued tensions between old and new ways of care delivery are affecting PHC reform progress at all levels and require resolution if reform is to achieve desired goals.
■Despite good work under way, the situation is not well served by the unsatisfactory state of data, lack of interoperable information systems and insufficient available research across the country.”

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Transformation Lessons from Disease-based Strategies: An Environmental Scan – Canadian Health Services Research Foundation – 17 December 2011

Posted on January 17, 2012. Filed under: Chronic Disease Mgmt | Tags: |

Transformation Lessons from Disease-based Strategies: An Environmental Scan – Canadian Health Services Research Foundation – 17 December 2011

by Brasset-Latulippe, Anne; Verma, Jennifer; Mulvale, Gillian; Barclay, Kevin

“It is estimated that nearly 16 million Canadians, almost every other one of us, is living with a chronic condition. There are approximately nine million Canadians living with at least one of seven “high-impact, high-prevalence” chronic illnesses. As the population ages so does the increase in prevalence with a majority of Canadian seniors over the age of 65 reporting at least one chronic illness. Chronic illnesses have become a serious economic burden, with total direct medical costs and indirect productivity losses surpassing $93 billion a year. The importance of addressing these costs cannot be overstated. Even more staggering is the number of lives claimed by chronic illnesses–nearly three quarters of all deaths in Canada arise from only four types of chronic disease.iv Our international ranking when it comes to addressing chronic care delivery in primary care is no better–Canada ranked last out of seven countries.

Publicly-funded healthcare in Canada was largely designed to treat acute episodes of illness, not chronic conditions. Public health insurance plans, collectively referred to as medicare, primarily cover medically necessary hospital and physician services. Overall, the healthcare system in Canada is comprised of 14 healthcare systems – 10 provincial, three territorial and one federal. A recent assessment by the Canadian Academy of Health Sciences reported major gaps between the current functioning of the healthcare system and the needs of patients with chronic diseases. Simply put, healthcare in this country was not designed to meet the care needs of those living with a chronic condition, let alone of those living with multiple chronic conditions.

A more active and organized response for the management of chronic diseases in Canada is needed…”

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Provincial and Territorial Health System Priorities: An Environmental Scan – Canadian Health Services Research Foundation – 17 December 2011

Posted on January 17, 2012. Filed under: Health Mgmt Policy Planning | Tags: |

Provincial and Territorial Health System Priorities: An Environmental Scan – Canadian Health Services Research Foundation – 17 December 2011

by Brasset-Latulippe, Anne; Verma, Jennifer; Mulvale, Gillian; Barclay, Kevin

“Healthcare in Canada is decentralized into 14 health systems—13 provinces and territories and the Federal Government. Each of these involves a mixture of urban, rural and remote settings, all facing competing priorities and constrained budgets. A recent analysis shows that health spending is rising faster than the rate of economic growth.i In this context, along with the approaching expiry of the 10-Year Plan to Strengthen Health Care (2004), the Canadian Health Services Research Foundation (CHSRF) recognizes that this is a critical time to examine questions of health system sustainability, accessibility, quality and responsiveness.

As such, CHSRF undertook an environmental scan to explore the shared values and principles, goals and key health policy issues across provinces and territories. The scan used a framework analysis approach,ii examining strategic planning documents for the period of 2008-2011 that were available during the analysis—February-March 2011. At the same time, CHSRF consulted with senior policy-makers across provinces and territories in ministries of health, intergovernmental affairs and finance. This summary presents key findings from the framework analysis and face-to-face meetings.”

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