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Govind Rao

Health care coordinators may walk the picket line | Sault Star - 0 views

www.saultstar.com/...ators-may-walk-the-picket-line

from heather nursing nurses Ontario union home care bargaining

shared by Govind Rao on 28 Jan 15 - No Cached
  • January 27, 2015
  •  Health care coordinators at 10 Community Care Access Centres, including in Sault Ste Marie, may be on strike as early as Friday. The Ontario Nurses Association, the union who represents health care coordinators at 10 of the 14 centres in the province, and employers walked away from mediation talks on Jan. 19. Members will vote whether or not to ratify non-monetary items of their new contract on Thursday.
  • Community Care Access Centres (CCAC) employ a mix of registered nurses, nurse practitioners, social workers, and occupational therapists who coordinate care for those who need additional assistance after surgery, or who have a chronic condition that requires in-home care. The centres also coordinate care for seniors and patients who choose to die at home
Govind Rao

Effectiveness of quality improvement strategies for coordination of care to reduce use ... - 0 views

www.cmaj.ca/...E568.full

from heather waits emerg research

shared by Govind Rao on 20 Oct 14 - No Cached
  • Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis
  • improvement strategies for the coordination of care of frequent users of the health care system.
  • Interpretation: We found that quality improvement strategies for coordination of care reduced hospital admissions among patients with chronic conditions other than mental illness and reduced emergency department visits among older patients. Our results may help clinicians and policy-makers reduce utilization through the use of strategies that target the system (team changes, case management) and the patient (promotion of self-management).
Irene Jansen

Eliminating Waste in US Health Care - - JAMA - 1 views

jama.ama-assn.org/...jama.2012.362.full

sustainability spending us coordination overutilization

shared by Irene Jansen on 19 Mar 12 - No Cached
  • In just 6 categories of waste—overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse—the sum of the lowest available estimates exceeds 20% of total health care expenditures.
  • Obtaining savings directly—by simply lowering payments or paying for fewer services—seems the most obvious remedy.
  • Here is a better idea: cut waste.
  • ...16 more annotations...
  • The literature in this area identifies many potential sources of waste and provides a broad range of estimates of the magnitude of excess spending.
  • The Table shows estimates of the total cost of waste in each of these 6 categories both for Medicare and Medicaid and for all payers.
  • Failures of Care Delivery: the waste that comes with poor execution or lack of widespread adoption of known best care processes
  • this category represented between $102 billion and $154 billion in wasteful spending
  • Failures of Care Coordination: the waste that comes when patients fall through the slats in fragmented care.
  • represented between $25 billion and $45 billion in wasteful spending
  • Overtreatment: the waste that comes from subjecting patients to care that, according to sound science and the patients' own preferences, cannot possibly help them
  • represented between $158 billion and $226 billion in wasteful spending
  • Administrative Complexity
  • represented between $107 billion and $389 billion in wasteful spending
  • Pricing Failures: the waste that comes as prices migrate far from those expected in well-functioning markets, that is, the actual costs of production plus a fair profit.
  • US prices for diagnostic procedures such as MRI and CT scans are several times more than identical procedures in other countries.
  • represented between $84 billion and $178 billion in wasteful spending
  • Fraud and Abuse
  • represented between $82 billion and $272 billion in wasteful spending
  • Addressing the wedge designated “overtreatment,” for example, would require identifying specific clinical procedures, tests, medications, and other services that do not benefit patients and using a range of levers in policy, payment, training, and management to reduce their use in appropriate cases. The National Priorities Partnership program at the National Quality Forum has produced precisely such a list in cooperation with and with the endorsement of relevant medical specialty societies.
healthcare88

Oxford County public health workers urge management to bargain and avert a service disr... - 0 views

cupe.ca/avert-service-disruption-early

ontario cupe bargaining

shared by healthcare88 on 25 Oct 16 - No Cached
  • Oct 24, 2016
  • CUPE 1146 represents public health inspectors, hygienists, dental assistants, nutritionists, dieticians, program secretaries, parent resource visitors, epidemiologists, smoke free tobacco coordinator, youth engagement coordinator and public health planners. The workers’ last contract expired on December 31, 2015.
healthcare88

Private health care a big mistake - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|cbpo|20161015|258398912

Day privatization court

shared by healthcare88 on 17 Oct 16 - No Cached
  • Sat Oct 15 2016
  • While I must seriously disagree with Dr. Harry Pollett's letter to the editor in the Cape Breton Post ("Doctor offers support for private health care," Sept. 30), I do thank him for raising the issue of a parallel health system, i.e. a private-for-profit system. It came as no surprise that the Fraser Institute was referenced as supportive of such a system. Their idea of downloading health care innovation on individual provinces and territories as a way to "set the provinces free" begs the question, "free from what?" As pointed out in the Cape Breton Post of the same day, Canada's premiers, while pleading with the federal government to meet with them to collaborate on health care, tell us that impending changes, set to be implemented next year, will cost the provinces as much as a billion dollars. Innovating while being cut to the bone may be difficult.
  • And a "private-for-profit" system will get their specialists from where? With the losses we have already experienced, I'm not sure we have many more to give. And should Dr. Brian Day and his cohorts be successful and able to provide quick fixes to "suitable patients" who can afford their service for knees, hips and the like, I would suggest that wait times for those unable to pay will be even longer with the loss of specialists to private clinics. With the acceptance of "screened" patients, these clinics would almost certainly be extremely profitable, having a big turnover with shorter hospital stays and wait times. All this while leaving the public system to treat patients with more serious illnesses, requiring longer hospital stays, and fewer dollars to work with - the type of care that is costly, but which a caring society considers as essential. Yes, there is waste in our system. When drugs can receive a 20-year patent protection guaranteeing as much as a 1,500 per cent profit margin, when we have people forced to remain in hospital because we have no other facility to meet their needs, and when the one body that could truly help coordinate a national system based on the principles of the Canada Health Act refuses to meet with the provinces and territories, we have duplication, waste and an inability to deal from strength with pharmaceutical companies. We could go on, and I'm sure Dr. Pollett could make additional suggestions.
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  • In his concluding remarks, Canadian Medical Association (CMA) president Dr. Granger Avery posed this question recently at the Canada 2020 Summit: "Is it fair to place the full burden of health care costs on governments?" Does the CMA not realize that we pay for our health care through our taxation system? What we need is a coordinated health system based on the principles of the Canada Health Act with doctor, hospital and drug care available to all Canadians no matter where they live and how much money they have. While Dr. Day may in fact be successful, I for one do not wish him success. My wish is that the people we elect will see the need for leadership in improving a system we can indeed be proud of. Dr. Tom Gaskell
  • Bras d'Or (Past president of the Canadian Association of Retired Teachers)
Irene Jansen

Ivy Lynn Bourgeault: Health Care's Biggest Soap Opera - 0 views

www.huffingtonpost.ca/...ada-health-care_b_1373233.html

cof innovation hhr federal

shared by Irene Jansen on 27 Mar 12 - No Cached
  • a working group on health care innovation to examine three critical issues related to the health workforce. These issues include examining the scopes of practice of health care providers to better meet patient needs, better coordinated management of health human resources, and accelerated adoption of clinical practice guidelines (CPGs).
  • Typically, the public dialogue around the health workforce is narrowly focused on addressing shortages and other supply-related crises, real or imagined, so it is refreshing to see attention paid at this level to broader health workforce issues.
  • we are not so much suffering from a lack of health care professionals as from their inappropriate deployment
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  • first year enrolment in Canadian medical schools is now 80 per cent higher than a decade ago.
  • huge potential for nurse practitioners in primary care. Yet, implementation of this single evidence-based policy recommendation continues to be hamstrung by a maddening mix of professional resistance and lack of political will.
  • Scopes of practice, coordinated management, and CPGs have all come under a variety of committee, task force, working group, and Royal Commission lenses over the past two decades. As important as that work has been, there has been a frustrating lack of follow through or haphazard implementation on what are often a series of well crafted, evidence-based recommendations.
  • There is now a chorus of voices highlighting the need for better health workforce policy and planning
  • a pan-Canadian health workforce observatory.
  • an organization that would assemble health workforce data, information, and expertise to inform more rational approaches to policy development and health workforce deployment
  • Several other developed and developing countries have created such organizations
  • the standing committee supported the call for an observatory in its recommendations but, sadly, the federal government response did not even acknowledge that the recommendation had been made
Irene Jansen

Exploring options for physician payment in Canada / June 2 Webinar 2011 - 0 views

www2.gotomeeting.com/...368903162

conference doctors continuing care fee for service primary care fromdelicious

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    To manage healthcare expenditure in Canada, many believe we need to change the way we pay physicians. If so, then what are the options we should be considering? What models would improve efficiency and coordination across the continuum of care? On June
Irene Jansen

Listening for Prescriptions: A National Consultation on Pharmaceutical Policy Issues He... - 0 views

www.longwoods.com/22034

pharma

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Results: We found consensus on overarching policy goals: to provide all Canadians with equitable and sustainable access to necessary medicines. We also found widespread frustration that many key pharmaceutical policy issues in Canada – including improving prescription drug financing and pricing – have been persistent challenges owing to a lack of policy coordination. The coverage of extraordinarily costly medicines for serious conditions was identified as a rapidly emerging policy issue. Conclusion: Targeted research and knowledge translation activities can help address key policy issues and, importantly, challenges of policy coordination in Canada and thereby reduce inequity and inefficiency in policy approaches and outcomes.
  • Irene Jansen on 23 Jan 12
     
    Healthcare Policy 6(2) 2010: 48-66 Steve Morgan and Colleen M. Cunningham
Irene Jansen

Senate Social Affairs Committee review of the health accord- Evidence - March 10, 2011 - 0 views

www.parl.gc.ca/...22evb-e.htm

accord senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Dr. Jack Kitts, Chair, Health Council of Canada
  • In 2008, we released a progress report on all the commitments in the 2003 Accord on Health Care Renewal, and the 10-year plan to strengthen health care. We found much to celebrate and much that fell short of what could and should have been achieved. This spring, three years later, we will be releasing a follow-up report on five of the health accord commitments.
  • We have made progress on wait times because governments set targets and provided the funding to tackle them. Buoyed by success in the initial five priority areas, governments have moved to address other wait times now. For example, in response to the Patients First review, the Saskatchewan government has promised that by 2014, no patient will wait longer than three months for any surgery. Wait times are a good example that progress can be made and sustained when health care leaders develop an action plan and stick with it.
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  • Canada has catching up to do compared to other OECD countries. Canadians have difficulty accessing primary care, particularly after hours and on weekends, and are more likely to use emergency rooms.
  • only 32 per cent of Canadians had access to more than one primary health care provider
  • In Peterborough, Ontario, for example, a region-wide shift to team-based care dropped emergency department visits by 15,000 patients annually and gave 17,000 more access to primary health care.
  • We believe that jurisdictions are now turning the corner on primary health care
  • Sustained federal funding and strong jurisdictional direction will be critical to ensuring that we can accelerate the update of electronic health records across the country.
  • The creation of a national pharmaceutical strategy was a critical part of the 10-year plan. In 2011, today, unfortunately, progress is slow.
  • Your committee has produced landmark reports on the importance of determinants of health and whole-of- government approaches. Likewise, the Health Council of Canada recently issued a report on taking a whole-of- government approach to health promotion.
  • there have also been improvements on our capacity to collect, interpret and use health information
  • Leading up to the next review, governments need to focus on health human resources planning, expanding and integrating home care, improved public reporting, and a continued focus on quality across the entire system.
  • John Wright, President and CEO, Canadian Institute for Health Information
  • While much of the progress since the 10-year plan has been generated by individual jurisdictions, real progress lies in having all governments work together in the interest of all Canadians.
  • the Canada Health Act
  • Since 2008, rather than repeat annual reporting on the whole, the Health Council has delved into specific topic areas under the 2003 accord and the 10-year plan to provide a more thorough analysis and reporting.
  • We have looked at issues around pharmaceuticals, primary health care and wait times. Currently, we are looking at the issues around home care.
  • John Abbott, Chief Executive Officer, Health Council of Canada
  • I have been a practicing physician for 23 years and a CEO for 10 years, and I would say, probably since 2005, people have been starting to get their heads around the fact that this is not sustainable and it is not good quality.
  • Much of the data you hear today is probably 18 months to two years old. It is aggregate data and it is looking at high levels. We need to get down to the health service provider level.
  • The strength of our ability to report is on the data that CIHI and Stats Canada has available, what the research community has completed and what the provinces, territories and Health Canada can provide to us.
  • We have a very good working relationship with the jurisdictions, and that has improved over time.
  • One of the strengths in the country is that at the provincial level we are seeing these quality councils taking on significant roles in their jurisdictions.
  • As I indicated in my remarks, dispute avoidance activity occurs all the time. That is the daily activity of the Canada Health Act division. We are constantly in communication with provinces and territories on issues that come to our attention. They may be raised by the province or territory, they may be raised in the form of a letter to the minister and they may be raised through the media. There are all kinds of occasions where issues come to our attention. As per our normal practice, that leads to a quite extensive interaction with the province or territory concerned. The dispute avoidance part is basically our daily work. There has never actually been a formal panel convened that has led to a report.
  • each year in the Canada Health Act annual report, is a report on deductions that have been made from the Canada Health Transfer payments to provinces in respect of the conditions, particularly those conditions related to extra billing and user fees set out in the act. That is an ongoing activity.
  • there has been progress. In some cases, there has been much more than in others.
  • How many government programs have been created as a result of the accord?
  • The other data set is on bypass surgery that is collected differently in Quebec. We have made great strides collectively, including Quebec, in developing the databases, but it takes longer because of the nature and the way in which they administer their systems.
  • I am a director of the foundation of St. Michael's Hospital in Toronto
  • Not everyone needs to have a family doctor; they need access to a family health team.
  • With all the family doctors we have now after a 47-per-cent-increase in medical school enrolment, we just need to change the way we do it.
  • The family doctors in our hospital feel like second-class citizens, and they should not. Unfortunately, although 25 years ago the family doctor was everything to everybody, today family doctors are being pushed into more of a triage role, and they are losing their ability.
  • The problem is that the family doctor is doing everything for everybody, and probably most of their work is on the social end as opposed to diagnostics.
  • At a time when all our emergency departments are facing 15,000 increases annually, Peterborough has gone down 15,000, so people can learn from that experience.
  • The family health care team should have strong family physicians who are focused on diagnosing, treating and controlling chronic disease. They should not have to deal with promotion, prevention and diet. Other health providers should provide all of that care and family doctors should get back to focus.
  • I have to be able to reach my doctor by phone.
  • They are busy doing all of the other things that, in my mind, can be done well by a team.
  • That is right.
  • if we are to move the yardsticks on improvement, sustainability and quality, we need that alignment right from the federal government to the provincial government to the front line providers and to the health service providers to say, "We will do this."
  • We want to share best practices.
  • it is not likely to happen without strong direction from above
  • Excellent Care for All Act
  • quality plans
  • with actual strategies, investments, tactics, targets and outcomes around a number of things
  • Canadian Hospital Reporting Project
  • by March of next year we hope to make it public
  • performance, outcomes, quality and financials
  • With respect to physicians, it is a different story
  • We do not collect data on outcomes associated with treatments.
  • which may not always be the most cost effective and have the better outcome.
  • We are looking at developing quality indicators that are not old data so that we can turn the results around within a month.
  • Substantive change in how we deliver health care will only be realized to its full extent when we are able to measure the cost and outcome at the individual patient and the individual physician levels.
  • In the absence of that, medicine remains very much an art.
  • Senator Eaton
  • There are different types of benchmarks. For example, there is an evidence-based benchmark, which is a research of the academic literature where evidence prevails and a benchmark is established.
  • The provinces and territories reported on that in December 2005. They could not find one for MRIs or CT scans. Another type of benchmark coming from the medical community might be a consensus-based benchmark.
  • universal screening
  • A year and a half later, we did an evaluation based on the data. Increased costs were $400 per patient — $1 million in my hospital. There was no reduction in outbreaks and no measurable effect.
  • For the vast majority of quality benchmarks, we do not have the evidence.
  • A thorough research of the literature simply found that there are no evidence-based benchmarks for CT scans, MRIs or PET scans.
  • We have to be careful when we start implementing best practices because if they are not based on evidence and outcomes, we might do more harm than good.
  • The evidence is pretty clear for the high acuity; however, for the lower acuity, I do not think we know what a reasonable wait time is
  • If you are told by an orthopaedic surgeon that there is a 99.5 per cent chance that that lump is not cancer, and the only way you will know for sure is through an MRI, how long will you wait for that?
  • Senator Cordy: Private diagnostic imaging clinics are springing up across all provinces; and public reaction is favourable. The public in Nova Scotia have accepted that if you want an MRI the next day, they will have to pay $500 at a private clinic. It was part of the accord, but it seems to be the area where we are veering into two-tiered health care.
  • colorectal screening
  • the next time they do the statistics, there will be a tremendous improvement, because there is a federal-provincial cancer care and front-line provider
  • adverse drug effects
  • over-prescribing
  • There are no drugs without a risk, but the benefits far outweigh the risks in most cases.
  • catastrophic drug coverage
  • a patchwork across the country
  • with respect to wait times
  • Having coordinated care for those people, those with chronic conditions and co-morbidity, is essential.
  • The interesting thing about Saskatchewan is that, on a three-year trending basis, it is showing positive improvement in each of the areas. It would be fair to say that Saskatchewan was a bit behind some of the other jurisdictions around 2004, but the trending data — and this will come out later this month — shows Saskatchewan making strides in all the areas.
  • In terms of the accord itself, the additional funds that were part of the accord for wait-times reduction were welcomed by all jurisdictions and resulted in improvements in wait times, certainly within the five areas that were identified as well as in other surgical areas.
  • We are working with the First Nations, Statistics Canada, and others to see what we can do in the future about identifiers.
  • Have we made progress?
  • I do not think we have the data to accurately answer the question. We can talk about proxies for data and proxies for outcome: Is it high on the government's agenda? Is it a directive? Is there alignment between the provincial government and the local health service providers? Is it a priority? Is it an act of legislation? The best way to answer, in my opinion, is that because of the accord, a lot of attention and focus has been put on trying to achieve it, or at least understanding that we need to achieve it. A lot of building blocks are being put in place. I cannot tell you exactly, but I can give you snippets of where it is happening. The Excellent Care For All Act in Ontario is the ultimate building block. The notion is that everyone, from the federal, to the provincial government, to the health service providers and to the CMA has rallied around a better health system. We are not far from giving you hard data which will show that we have moved yardsticks and that the quality is improving. For the most part, hundreds of thousands more Canadians have had at least one of the big five procedures since the accord. I cannot tell you if the outcomes were all good. However, volumes are up. Over the last six years, everybody has rallied around a focal point.
  • The transfer money is a huge sum. The provinces and territories are using the funds to roll out their programs and as they best see fit. To what extent are the provinces and territories accountable to not just the federal government but also Canadians in terms of how effectively they are using that money? In the accord, is there an opportunity to strengthen the accountability piece so that we can ensure that the progress is clear?
  • In health care, the good news is that you do not have to incent people to do anything. I do not know of any professionals more competitive than doctors or executives more competitive than executives of hospitals. Give us the data on how we are performing; make sure it is accurate, reliable, and reflective, and we will move mountains to jump over the next guy.
  • There have been tremendous developments in data collection. The accord played a key role in that, around wait times and other forms of data such as historic, home care, long term care and drug data that are comparable across the country. Without question, there are gaps. It is CIHI's job to fill in those gaps as resources permit.
  • The Health Council of Canada will give you the data as we get it from the service providers. There are many building blocks right now and not a lot of substance.
  • send him or her to the States
  • Are you including in the data the percentage of people who are getting their work done elsewhere and paying for it?
  • When we started to collect wait time data years back, we looked at the possibility of getting that number. It is difficult to do that in a survey sampling the population. It is, in fact, quite rare that that happens.
  • Do we have a leader in charge of this health accord? Do we have a business plan that is reviewed quarterly and weekly so that we are sure that the things we want worked on are being worked on? Is somebody in charge of the coordination of it in a proper fashion?
  • Dr. Kitts: We are without a leader.
  • Mr. Abbott: Governments came together and laid out a plan. That was good. Then they identified having a pharmaceutical strategy or a series of commitments to move forward. The system was working together. When the ministers and governments are joined, progress is made. When that starts to dissipate for whatever reason, then we are 14 individual organization systems, moving at our own pace.
  • You need a business plan to get there. I do not know how you do it any other way. You can have ideas, visions and things in place but how do you get there? You need somebody to manage it. Dr. Kitts: I think you have hit the nail on the head.
  • The Chair: If we had one company, we would not have needed an accord. However, we have 14 companies.
  • There was an objective of ensuring that 50 per cent of Canadians have 24/7 access to multidisciplinary teams by 2010. Dr. Kitts, in your submission in 2009, you talked about it being at 32 per cent.
  • there has been a tremendous focus for Ontario on creating family health teams, which are multidisciplinary primary health care teams. I believe that is the case in the other jurisdictions.
  • The primary health care teams, family health care teams, and inter-professional practice are all essentially talking about the same thing. We are seeing a lot of progress. Canadian Health Services Research Foundation is doing a lot of work in this area to help the various systems to embrace it and move forward.
  • The question then came up about whether 50 per cent of the population is the appropriate target
  • If you see, for instance, what the Ontario government promotes in terms of needing access, they give quite a comprehensive list of points of entry for service. Therefore, in terms of actual service, we are seeing that points of service have increased.
  • The key thing is how to get alignment from this accord in the jurisdictions, the agencies, the frontline health service providers and the docs. If you get that alignment, amazing things will happen. Right now, every one of those key stakeholders can opt out. They should not be allowed to opt out.
  • the national pharmaceutical strategy
  • in your presentation to us today, Dr. Kitts, you said it has stalled. I have read that costing was done and a few minor things have been achieved, but really nothing is coming forward.
  • The pharmacists' role in health care was good. Procurement and tendering are all good. However, I am not sure if it will positively impact the person on the front line who is paying for their drugs.
  • The national pharmaceutical strategy had identified costing around drugs and generics as an issue they wanted to tackle. Subsequently, Ontario tackled it and then other provinces followed suit. The question to ask is: Knowing that was an issue up front, why would not they, could not they, should not they have acted together sooner? That was the promise of the national pharmaceutical strategy, or NPS. I would say it was an opportunity lost, but I do not think it is lost forever.
  • Irene Jansen on 23 Jan 12
     
    CIHI Health Canada Statistics Canada
Irene Jansen

Soaring Health Care Costs Due To Technology, Not Aging Society :: Longwoods.com - 0 views

www.longwoods.com/22608

accord continuing care

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Grim predictions that our rapidly aging society will act like a ‘grey tsunami’ to overwhelm and bankrupt our health care system aren’t accurate, according to the University of Victoria’s Canada Research Chair in Social Gerontology Neena Chappell and Marcus Hollander, president of Hollander Analytical Services.
  • the primary factors in increasing health care costs are technology and increased service provision to people of all ages
  • significant opportunities for cost savings while maintaining quality care for seniors, and that significant savings can be achieved through better organization and management of their health services
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  • “In a more integrated system of care delivery, it is possible to both save money and increase the quality of care at the same time.”
  • Eleven commentaries were written by leading health policy experts across Canada to respond to the lead paper by Chappell and Hollander, who also wrote a response to the commentaries.
  • One system including community services such as meals on wheels, non-professional supportive services, professional home care services, supportive housing, long-term care facilities and specialized geriatric assessment and treatment units in hospitals would also have one overall budget. Professional case managers would coordinate care and assess needs, develop customized care plans, and authorize access to any of the services in the integrated system. They would also coordinate care with other parts of the health system, such as hospitals
  • budgets for long-term supportive care that allow people to remain in their homes have been frozen or reduced
  • While some seniors do need some professional care, say the authors, often their needs can be addressed primarily by non-professional supportive care such as feeding, bathing, and maintaining a clean living environment.
Irene Jansen

Senate Social Affairs Committee review of the health accord, Evidence, September 29, 2011 - 0 views

www.parl.gc.ca/...49055-e.htm

accord waits senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations
  • eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation
  • Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?
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  • While the access agenda has been the central focal point of the 2004 health accord, it is time to have the 2014 health accord focus on quality, of which access is one important dimension, with the others being effectiveness, safety, efficiency, appropriateness, provider competence and acceptability.
  • we also propose three specific funds that are strategically focused in areas that can contribute to improved access and wait time
  • Can the 2014 health accord act as a catalyst to ensure appropriate post-hospital supportive and preventive care strategies, facilitate integration of primary health care with the rest of the health care system and enable innovative approaches to health care delivery? Is there an opportunity to move forward with new models of primary health care that focus on personal accountability for health, encouraging citizens to work in partnership with their primary care providers and thereby alleviating some of the stress on emergency departments?
  • one in five hospital beds are being occupied by those who do not require hospital care — these are known as alternative level of care patients, or ALC patients
  • the creation of an issue-specific strategically targeted fund designed to move beyond pilot projects and accelerate the creation of primary health care teams — for example, team-based primary health care funds could be established — and the creation of an infrastructure fund, which we call a community-based health infrastructure fund to assist in the development of post-hospital care capacity, coupled with tax policies designed to defray expenses associated with home care
  • consider establishing a national health innovation fund, of which one of its stated objectives would be to promote the sharing of applied health system innovations across the country with the goal of improving the delivery of quality health services. This concept would be closely aligned with the work of the Canadian Institutes of Health Research in developing a strategy on patient oriented research.
  • focus the discussion on what is needed to ensure that Canada is a high performing system with an unshakable focus on quality
  • of the Wait Time Alliance
  • Dr. Simpson
  • the commitment of governments to improve timely access to care is far from being fulfilled. Canadians are still waiting too long to access necessary medical care.
  • Table 1 of our 2011 report card shows how provinces have performed in addressing wait times in the 10-year plan's five priority areas. Of note is the fact that we found no overall change in letter grades this year over last.
  • We believe that addressing the gap in long-term care is the single more important action that could be taken to improve timely access to specialty care for Canadians.
  • The WTA has developed benchmarks and targets for an additional seven specialties and uses them to grade progress.
  • the lack of attention given to timely access to care beyond the initial five priority areas
  • all indications are that wait times for most specialty areas beyond the five priority areas are well beyond the WTA benchmarks
  • we are somewhat encouraged by the progress towards standardized measuring and public reporting on wait times
  • how the wait times agenda could be supported by a new health accord
  • governments must improve timely access to care beyond the initial five priority areas, as a start, by adopting benchmarks for all areas of specialty care
  • look at the total wait time experience
  • The measurements we use now do not include the time it takes to see a family physician
  • a patient charter with access commitments
  • Efficiency strategies, such as the use of referral guidelines and computerized clinical support systems, can contribute significantly to improving access
  • In Ontario, for example, ALC patients occupy one in six hospital beds
  • Our biggest fear is government complacency in the mistaken belief that wait times in Canada largely have been addressed. It is time for our country to catch up to the other OECD countries with universal, publicly funded health care systems that have much timelier access to medical care than we do.
  • The progress that has been made varies by province and by region within provinces.
  • Dr. Michael Schull, Senior Scientist, Institute for Clinical Evaluative Sciences
  • Many provinces in Canada, and Ontario in particular, have made progress since the 2004 health accord following large investments in health system performance that targeted the following: linking more people with family doctors; organizational changes in primary care, such as the creation of inter-professional teams and important changes to remuneration models for physicians, for example, having a roster of patients; access to select key procedures like total hip replacement and better access to diagnostic tests like computer tomography. As well, we have seen progress in reducing waiting times in emergency departments in some jurisdictions in Canada and improving access to community-based alternatives like home care for seniors in place of long-term care. These have been achieved through new investments such as pay for performance incentives and policy change. They have had some important successes, but the work is incomplete.
  • Examples of the ongoing challenges that we face include substantial proportions of the population who do not have easy access to a family doctor when needed, even if they have a family doctor; little progress on improving rates of eligible patients receiving important preventive care measures such as pap smears and mammograms; continued high utilization of emergency departments and walk-in clinics compared to other countries; long waits, which remain a problem for many types of care. For example, in emergency departments, long waits have been shown to result in poor patient experience and increased risk of adverse outcomes, including deaths.
  • Another example is unclear accountability and antiquated mechanisms to ensure smooth transitions in care between providers and provider organizations. An example of a care transition problem is the frequent lack of adequate follow-up with a family doctor or a specialist after an emergency department visit because of exacerbation of a chronic disease.
  • A similar problem exists following discharge from hospital.
  • Poorly integrated and coordinated care leads to readmission to hospital
  • This happens despite having tools to predict which patients are at higher risk and could benefit from more intensive follow-up.
  • Perverse incentives and disincentives exist, such as no adjustment in primary care remuneration to care for the sickest patients, thereby disincenting doctors to roster patients with chronic illnesses.
  • Critical reforms needed to achieve health system integration include governance, information enablers and incentives.
  • we need an engaged federal government investing in the development and implementation of a national health system integration agenda
  • complete absence of any mention of Canada as a place where innovative health system reform was happening
  • Dr. Brian Postl, Dean of Medicine, University of Manitoba, as an individual
  • the five key areas of interest were hips and knees, radiology, cancer care, cataracts and cardiac
  • no one is quite sure where those five areas came from
  • There was no scientific base or evidence to support any of the benchmarks that were put in place.
  • I think there is much less than meets the eye when we talk about what appropriate benchmarks are.
  • The one issue that was added was hip fractures in the process, not just hip and knee replacement.
  • in some areas, when wait-lists were centralized and grasped systematically, the list was reduced by 30 per cent by the act of going through it with any rigour
  • When we started, wait-lists were used by most physicians as evidence that they were best of breed
  • That continues, not in all areas, but in many areas, to be a key issue.
  • The capacity of physicians to give up waiting lists into more of a pool was difficult because they saw it very much, understandably, as their future income.
  • There were almost no efforts in the country at the time to use basic queuing theory
  • We made a series of recommendations, including much more work on the research about benchmarks. Can we actually define a legitimate benchmark where, if missed, the evidence would be that morbidity or mortality is increasing? There remains very little work done in that area, and that becomes a major problem in moving forward into other benchmarks.
  • the whole process needed to be much more multidisciplinary in its focus and nature, much more team-based
  • the issue of appropriateness
  • Some research suggests the number of cataracts being performed in some jurisdictions is way beyond what would be expected to be needed
  • the accord did a very good job with what we do, but a much poorer job around how we do it
  • Most importantly, the use of single lists is needed. This is still not in place in most jurisdictions.
  • the accord has bought a large amount of volume and a little bit of change. I think any future accords need to lever any purchase of volume or anything else with some capacity to purchase change.
  • We have seen volumes increase substantially across all provinces, without major detriment to other surgical or health care areas. I think it is a mediocre performance. Volume has increased, but we have not changed how we do business very much. I think that has to be the focus of any future change.
  • with the last accord. Monies have gone into provinces and there has not really been accountability. Has it made a difference? We have not always been able to tell that.
  • There is no doubt that the 2004-14 health accord has had a positive influence on health care delivery across the country. It has not been an unqualified success, but nonetheless a positive force.
  • It is at these transition points, between the emergency room and being admitted to hospital or back to the family physician, where the efficiencies are lost and where the expectations are not met. That is where medical errors are generated. The target for improvement is at these transitions of care.
  • I am not saying to turn off the tap.
  • the government has announced, for example, a 6 per cent increase over the next two or three years. Is that a sufficient financial framework to deal with?
  • Canada currently spends about the same amount as OECD countries
  • All of those countries are increasing their spending annually above inflation, and Canada will have to continue to do that.
  • Many of our physicians are saying these five are not the most important anymore.
  • they are not our top five priority areas anymore and frankly never were
  • this group of surgeons became wealthy in a short period of time because of the $5.5 billion being spent, and the envy that caused in every other surgical group escalated the costs of paying physicians because they all went back to the market saying, "You have left us out," and that became the focus of negotiation and the next fee settlements across the country. It was an unintended consequence but a very real one.
  • if the focus were to shift more towards system integration and accountability, I believe we are not going to lose the focus on wait times. We have seen in some jurisdictions, like Ontario, that the attention to wait times has gone beyond those top five.
  • people in hospital beds who do not need to be there, because a hospital bed is so expensive compared to the alternatives
  • There has been a huge infusion of funds and nursing home beds in Ontario, Nova Scotia and many places.
  • Ontario is leading the way here with their home first program
  • There is a need for some nursing home beds, but I think our attention needs to switch to the community resources
  • they wind up coming to the emergency room for lack of anywhere else to go. We then admit them to hospital to get the test faster. The weekend goes by, and they are in bed. No one is getting them up because the physiotherapists are not working on the weekend. Before you know it, this person who is just functioning on the edge is now institutionalized. We have done this to them. Then they get C. difficile and, before you know, it is a one-way trip and they become ALC.
  • I was on the Kirby committee when we studied the health care system, and Canadians were not nearly as open to changes at that time as I think they are in 2011.
  • there is no accountability in terms of the long-term care home to take those patients in with any sort of performance metric
  • We are not all working on the same team
  • One thing I heard on the Aging Committee was that we should really have in place something like the Veterans Independence Program
  • some people just need someone to make a meal or, as someone mentioned earlier, shovel the driveway or mow the lawn, housekeeping types of things
  • I think the risks of trying to tie every change into innovation, if we know the change needs to happen — and there is lots of evidence to support it — it stops being an innovation at that point and it really is a change. The more we pretend everything is an innovation, the more we start pilot projects we test in one or two places and they stay as pilot projects.
  • the PATH program. It is meant to be palliative and therapeutic harmonization
  • has been wildly successful and has cut down incredibly on lengths of stay and inappropriate care
  • Where you see patient safety issues come to bear is often in transition points
  • When you are not patient focused, you are moving patients as entities, not as patients, between units, between activities or between functions. If we focus on the patient in that movement, in that journey they have through the health system, patient safety starts improving very dramatically.
  • If you require a lot of home care that is where the gap is
  • in terms of emergency room wait times, Quebec is certainly among the worst
  • Ontario has been quite successful over the past few years in terms of emergency wait times. Ontario’s target is that, on average, 90 per cent of patients with serious problems spend a maximum of eight hours in the emergency room.
  • One of the real opportunities, building up to the accord, are for governments to define the six or ten or twelve questions they want answered, and then ensure that research is done so that when we head into an accord, there is evidence to support potential change, that we actually have some ideas of what will work in moving forward future changes.
  • We are all trained in silos and then expected to work together after we are done training. We are now starting to train them together too.
  • The physician does not work for you. The physician does not work for the health system. The physician is a private practitioner who bills directly to the health care system. He does not work for the CEO of the hospital or for the local health region. Therefore, your control and the levers you have with that individual are limited.
  • the customer is always right, the person who is getting the health care
  • It is refreshing to hear something other than the usual "we need more money, we absolutely need more money for that". Without denying the fact that, since the population and the demographics are going to require it, we have to continue making significant investments in health, I think we have to be realistic and come up with new ways of doing things.
  • The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services.
  • How do you help patients navigate a system that is so complex? How do you coordinate appointments, ensure the appointments are necessary and make sure that the consultants are communicating with each other so one is not taking care of the renal problem and the other the cardiac problem, but they are not communicating about the patient? That is frankly a frequent issue in the health system.
  • There may be a patient who requires Test Y, X, and Z, and most patients require that package. It is possible to create a one-stop shop kind of model for patient convenience and to shorten overall wait times for a lot of patients that we do not see. There are some who are very complicated and who have to be navigated through the system. This is where patient navigators can perhaps assist.
  • There have been some good studies that have looked at CT and MRI utilization in Ontario and have found there are substantial portions where at least the decision to initiate the test was questionable, if not inappropriate, by virtue of the fact that the results are normal, it was a repeat of prior tests that have already been done or the clinical indication was not there.
  • Designing a system to implement gates, so to speak, so that you only perform tests when appropriate, is a challenge. We know that in some instances those sorts of systems, where you are dealing with limited access to, say, CT, and so someone has to review the requisition and decide on its appropriateness, actually acts as a further obstacle and can delay what are important tests.
  • The simple answer is that we do not have a good approach to determining the appropriateness of the tests that are done. This is a critical issue with respect to not just diagnostic tests but even operative procedures.
  • the federal government has very little information about how the provinces spend money, other than what the provinces report
  • should the money be conditional? I would say absolutely yes.
Govind Rao

Health Council Canada - 0 views

healthcouncilcanada.ca/rpt_det.php

from heather health council of canada primary care

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  • Govind Rao on 24 Feb 14
     
    Better coordination of screening
Govind Rao

Conservatives ignoring health care staffing crisis NorthumberlandView.ca - 0 views

www.northumberlandview.ca/index.php

from heather ndp staffing

shared by Govind Rao on 25 Feb 14 - No Cached
  • Contributed by admin on Feb 19, 2014 - 09:25 AM
  • The NDP is outraged that eight years after Stephen Harper promised to reduce wait times for family doctors, four million Canadians still can’t find a family physician and worse yet, more and more doctors can’t find work.
  • “There is no good reason why any Canadian should wait months to get care, while qualified doctors can’t find work,” said NDP Health critic Libby Davies (Vancouver – East). “New Democrats have long proposed a practical solution that will find work for doctors and reduce wait times for Canadians. Instead of acting, the Conservatives are turning their backs on health care.”
  • ...1 more annotation...
  • The NDP is proposing a Pan-Canadian Health Human Resources Strategy whereby federal, provincial and territorial governments coordinate training and working opportunities for doctors and other health professionals, reducing wait times in the process. The United Kingdom and Australia currently use a national approach to coordinate human resources in their health care systems. “Once again the Conservatives have failed Canadians. In their 2012 budget they short-changed the provinces by $31-billion and Canadians are paying the price,” said NDP deputy Health critic Dany Morin (Chicoutimi – Le Fjord).
Govind Rao

Age-Friendly Communities in Ontario: Multi-Level Governance, Coordination Cha... - 0 views

irpp.org/...age-friendly-communities

from heather conference ltc

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  • Age-Friendly Communities in Ontario: Multi-Level Governance, Coordination Challenges and Policy Implications Symposium November 4, 2013 – November 5, 2013 Chestnut Residence and Conference Centre University of Toronto 89 Chestnut Street, Toronto
Govind Rao

Effectiveness of quality improvement strategies for coordination of care to reduce use ... - 0 views

www.cmaj.ca/...cmaj.140289.full.pdf+html

from heather ltc continuing care coordination

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  • Govind Rao on 18 Sep 14
     
    Andrea C. Tricco PhD, Jesmin Antony MSc, Noah M. Ivers MD PhD, Huda M. Ashoor BSc, Paul A. Khan PhD, Erik Blondal BSc, Marco Ghassemi MSc, Heather MacDonald MLIS, Maggie H. Chen PhD, Lianne Kark Ezer MSc, Sharon E. Straus MD MSc
Govind Rao

Health care workers strike stretches on | Sault Star - 0 views

www.saultstar.com/...re-workers-strike-stretches-on

from heather Ontario strike home care nursing nurses

shared by Govind Rao on 03 Feb 15 - No Cached
  • Sarah Petz  Tuesday, February 3, 2015
  • Dozens of health care workers in Sault Ste. Marie braved the bitter cold to walk the picket line for another day.   They are part of the close to 3000 Community Care Access Centre (CCAC) health care workers across Ontario who have been on strike since Friday after nine of the ten bargaining units represented by the Ontario Nurses’ Association voted to walk off the job.   Community Care Access Centres employ a mix of registered nurses, nurse practitioners, social workers, and occupational therapists who coordinate care for those who need additional assistance after surgery, or who have a chronic condition that requires in-home care. The centres also coordinate care for seniors, and patients who choose to die at home.The are a total of 14 centres in the province.
Govind Rao

St. Joe's integrated health-care model guides new home care report - Latest Hamilton ne... - 0 views

www.cbc.ca/...new-home-care-report-1.2994206

from heather home care Ontario

shared by Govind Rao on 16 Mar 15 - No Cached
  • Integrated Comprehensive Care Program pairs patients with a coordinator throughout care process
  • Mar 14, 2015
  • A pilot project of integrated health care tested in Hamilton has lent some wisdom to a new report aimed at improving home and community care in Ontario. The Integrated Comprehensive Care Program (ICC) at St. Joseph’s Health System is testing a model of “integrated case management” among health-care providers. Started in the spring of 2012, it pairs patients with a care coordinator — usually a registered nurse — from pre-operation treatments to post-surgical home care.
Doug Allan

LHIN puts The Scarborough Hospital's plans for change on hold - Infomart - 0 views

www.fpinfomart.ca/...164664414

scarborough restructuring cuts

shared by Doug Allan on 28 Mar 13 - No Cached
  • he regional health authority has surprised The Scarborough Hospital by voting down plans to split complex and day surgeries between campuses and move all births to the Birchmount site, ordering the hospital to continue talks with physicians and the public.
  • to immediately investigate ways it can share services with Rouge Valley Health Services, which runs Scarborough's other hospital site, Centenary.
  • The decisions leave The Scarborough Hospital's $15.7-million budget shortfall unresolved, and every month of delay costs the hospital $1.3 million more, said TSH vice president Marla Fryers
  • ...3 more annotations...
  • But LHIN CEO Debbie Hammons said her organization, which overseas delivery of health care from Scarborough to Peterborough, has been "inundated" in the last few weeks with calls, emails and petitions opposing the changes.
  • nstead, TSH was told to publicly review both of its service changes with a panel of physicians and community leaders which "must address the concerns and risks that have been identified by stakeholders" and report back to the LHIN within 90 days. The authority, backed by the provincial government, has its own Clinical Service Plan calling for greater coordination between RVHS and TSH on vascular surgery, maternal health and pediatrics.
  • On Wednesday, it said the hospitals should begin work on possible "integrations" with each other in order to deliver better care in Scarborough. The LHIN called for a "directional report" on this goal within 60 days and a more detailed study in six months.
  • Doug Allan on 28 Mar 13
     
    Scarbrough intergration put on hold by LHIN
Heather Farrow

Home care services for 1500 inner city patients still in peril despite today's funding ... - 0 views

cupe.ca/te-todays-funding-announcement

cupe Ontario home care cuts

shared by Heather Farrow on 03 Aug 16 - No Cached
  • Jul 20, 2016
  • Home care services of more than 1500 infirm and elderly, inner city patients provided by Toronto’s Neighbourhood Group are still in peril of coming to an end despite today’s announcement of additional sector-wide funding by the provincial government.
  • Heather Duff, Chair of CUPE Ontario’s Health Care Workers Coordinating Committee. “Both the Premier and the Minister of Health are well aware that Neighbourhood Group has said they will have to shut down their services without additional money to cover existing costs.”
Heather Farrow

Public solicitation for organ donors: a time for direction in Canada - 0 views

www.cmaj.ca/487

cma organs

shared by Heather Farrow on 18 Apr 16 - No Cached
  • CMAJ April 19, 2016 vol. 188 no. 7 First published February 29, 2016, doi: 10.1503/cmaj.150964
  • The disparity between supply and demand for transplantable solid organs has resulted in strategies to drive increased organ donation, including public solicitations for living donors. Public organ solicitation occurs when a recipient or their representative solicits an organ for transplantation by public broadcast (e.g., social media or a public notice). The intended donor and recipient may not have a prior relationship. Lack of regulation of public solicitations for organ donation in Canada is a cause for concern. We call for careful screening of altruistic donors within a well-organized system that links willing donors with a maximum number of beneficiaries.
  • Public solicitation for organs offers an opportunity to find a living donor for potential recipients who do not have one within their social or familial network. Thus, solicitations are a way to redress a somewhat natural injustice, whereby some people have more friends or family members who are willing to donate than others. Accepting these donations does not discriminate1 nor does it disadvantage those on the waiting list.2 Solicitation leads to access to an organ that would not otherwise have been available for donation.3 In addition to being a benefit to the direct recipient, every transplant reduces the demand on the waiting list.2 Solicitation can also increase the awareness of organ shortages and may elicit more donors for other recipients.3
  • ...7 more annotations...
  • However, there are concerns. Organ solicitations have been criticized as unfair, because they enable donation to identified recipients rather than to a recipient on a waiting list. Celebrity status and access to resources clearly provide increased opportunities to find a donor. A person with a high profile or more appealing story may be perceived as getting ahead in the transplant system, which could influence the public against organ donation.4 Recipients who are computer literate, social media savvy or English-speaking have enhanced access to potential donors beyond their local community and are more likely to find a donor than those without these characteristics.2 Publicity surrounding personal stories involving organ solicitation can be misleading and encourage offers to the solicitor, without considering donations to those with greatest need.5 However, all living donation is inequitable in that the donor chooses to whom to donate — generally someone they know — without any requirement to donate to the wait-list recipient with the greatest need.
  • One concern with public solicitations for organs is the potential for exposure of the recipient to harms from a donor who is unknown to them, which may in turn damage the reputation of transplant programs.3 Canadian law requires a minimum donor age for living donors, voluntary consent and no exchange of goods for an organ.6 Public solicitation may increase the potential for exchange of valuable considerations for an organ, because the donor is unknown to the recipient.
  • Two recent, well-publicized Canadian cases focused attention on these issues. The owner of the Ottawa Senators hockey team, who needed a new liver, used his public profile to solicit an anonymous donor.7 In the other case, the family of a young girl who needed a liver transplant made a public appeal through a Facebook page.8 The solicitation was fuelled by media attention surrounding this touching story, whereby the child’s twin had received liver tissue donated by their father, who could only donate once. The solicitation received more than 500 responses from people willing to donate.8 These two public solicitations for organs received markedly different public responses: one faced criticism9 and the other garnered sympathy. The difference in public perceptions was likely due to the different recipient profiles. In both cases, anonymous donors came forward, were screened and donated a part of their livers.
  • There are no guidelines for public solicitation of organs in Canada. Canadian transplant programs have had to address this issue on a case-by-case basis, often without consensus. Within Canada, different responses to organ solicitation by potential donors may be producing inequity of access to organs. Transplant programs and their patients could benefit from guidance on how to address the challenges raised by public solicitations. Many transplant doctors would be comfortable with public solicitation only if the donor became a nondirected altruistic donor, by which the organ is allocated to the next suitable recipient on the waiting list rather than to the actual solicitor (unpublished survey data, July 2015). Transplant doctors consider the next best thing to be to ensure that a relationship existed between the recipient and the solicited donor before donation occurs.
  • Donors who respond to public solicitations should be considered for transplantation. However, transplant programs must ensure that the motivation for donation is based on altruism rather than secondary intention, and that donors meet medical and psychosocial criteria for living donors, provide informed consent and agree to meet the requirements of the program regarding contact with the recipient. Although they should not be dissuaded from donating to the intended recipient, solicited donors should be made aware of alternatives such as donating to the recipient with the greatest need. A model is Canada’s National Kidney Paired Donation program. This program is the best option for candidates who have living kidney donors who are willing to donate and medically able, but who are incompatible with their intended
  • recipient. The program coordinates a chain of multiple transplants so that a willing donor’s organ can find its way to a compatible recipient while the intended recipient also receives an organ.10 This system allows the most people in need of an organ to get one. Even if the solicited donor and recipient are compatible, they can still choose to enter the National Kidney Paired Donation program as a pair, to benefit the greater transplant community, because a critical number of pairs are required for the overall success of the program.10 Whether donors from a public solicitation should remain anonymous to their recipients is a decision best left to the transplant program.
  • Donations of living organs are valued. Solicited organ donation helps to identify willing donors. It is an important facet of living donation and should be promoted. However, solicited organ donors should be encouraged to consider anonymous nondirected organ donation within systems, such as the National Kidney Paired Donation program, to maximize the number of patients in need who receive a transplant from a willing altruistic donor.
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