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Healthcare Quarterly

Marian Walsh
No abstract text is available yet for this article.
2016: Healthcare Quarterly
(no author information available yet)
No abstract text is available yet for this article.
2016: Healthcare Quarterly
Anne Hendry, Alison Taylor, Stewart Mercer, Peter Knight
The Scottish Parliament recently passed legislation on integrating healthcare and social care to improve the quality and outcomes of care and support for people with multiple and complex needs across Scotland. This ambitious legislation provides a national framework to accelerate progress in person-centred and integrated care and support for the growing number of people who have multiple physical and mental health conditions and complex needs. Additional investment and improvement capacity is helping to commission support and services that are designed and delivered with people in local communities and in partnership with housing, community, voluntary and independent sectors...
2016: Healthcare Quarterly
David McNeil, Roger Strasser, Nancy Lightfoot, Raymond Pong
The transition from hospital to home is a vulnerable period for patients with complex conditions, who are often frail, at risk for adverse events and unable to navigate a system of poorly coordinated care in the post-discharge period. Care transition interventions are seen as effective care coordinating mechanisms for reducing avoidable adverse events associated with the transition of the patient from the hospital to the home. A study was undertaken to evaluate the effectiveness of a care transition intervention involving a hand-off between a hospital-based care transitions nurse and a community-based rapid response nurse...
2016: Healthcare Quarterly
Onil Bhattacharyya, Michael Schull, Kaveh Shojania, Vicky Stergiopoulos, Gary Naglie, Fiona Webster, Ricardo Brandao, Tamara Mohammed, Jennifer Christian, Gillian Hawker, Lynn Wilson, Wendy Levinson
Integrating care for people with complex needs is challenging. Indeed, evidence of solutions is mixed, and therefore, well-designed, shared evaluation approaches are needed to create cumulative learning. The Toronto-based Building Bridges to Integrate Care (BRIDGES) collaborative provided resources to refine and test nine new models linking primary, hospital and community care. It used mixed methods, a cross-project meta-evaluation and shared outcome measures. Given the range of skills required to develop effective interventions, a novel incubator was used to test and spread opportunities for system integration that included operational expertise and support for evaluation and process improvement...
2016: Healthcare Quarterly
Martin Fortin, Martine Couture, Tarek Bouhali, Esther Leclerc, Moira Stewart
An integrated knowledge translation strategy is a key factor in fostering the implementation of practice changes. Building on a 15-year history of projects that include close collaboration between researchers and decision-makers in the Saguenay region of Quebec (Canada), the authors identify several key elements that resulted in practice changes in primary care and improved outcomes for patients with multimorbidity.
2016: Healthcare Quarterly
Charissa Levy, Sue Balogh, Emmi Perkins
In today's demographic landscape, with its aging population and increasing number of individuals who are living with multiple chronic conditions and comorbidities, the healthcare system is tasked with responding to the needs of medically complex individuals. However, the pressures arising from this emerging demographic are felt not only within the acute care sector at the point of medical crisis but along the entire continuum of the healthcare system. Rehabilitative care plays a key role in that continuum by providing the process through which individuals are engaged in interventions to address their functional (both cognitive and physical) and psychosocial care goals to help them carry on with the business of living...
2016: Healthcare Quarterly
Walter P Wodchis
This paper reviews approaches to performance measurement in health systems with particular attention to people with multimorbidity and complex health needs. Performance measurement should be informative and used by multiple stakeholders in order to align performance improvement efforts. System performance measures must allow for macro-system and meso-organization and provider-level reporting, and they should be relevant and important to stakeholders at each level, as well as to patients and all potential care recipients...
2016: Healthcare Quarterly
Michelle L A Nelson, Agnes Grudniewicz, Sarah Albadry
In Canada, policy makers are working to align services with the Stroke Rehabilitation Best Practice Recommendations (SRBPR). Complicating the application of clinical practice guidelines (CPGs) is the fact that most strokes occur in the context of other diagnoses. We sought to understand clinicians' use of the CPGs and ascertain how much guidance regarding multimorbidity was available in the SRBPR. Study results indicated that using the recommendations was problematic due to a perceived lack of guidance regarding comorbidities and multimorbidity, and concerns regarding the applicability to "real-life patients...
2016: Healthcare Quarterly
Carolyn Steele Gray, Stewart Mercer, Ted Palen, Brian McKinstry, Anne Hendry
Information technology (IT) in healthcare, also referred to as eHealth technologies, may offer a promising solution to the provision of better care and support for people who have multiple conditions and complex care needs, and their caregivers. eHealth technologies can include electronic medical records, telemonitoring systems and web-based portals, and mobile health (mHealth) technologies that enable information sharing between providers, patients, clients and their families. IT often acts as an enabler of improved care delivery, rather than being an intervention per se...
2016: Healthcare Quarterly
Ross E G Upshur
Ten years ago, complexity was not a term often used in primary care. In the last decade, however, the population seen in primary care has shifted, posing substantial challenges for both primary care providers and health systems. In this essay, I will document the approaches that evolved in an academic family practice environment to address the challenges posed by complex patients typified by multiple concurrent chronic conditions and social determinants challenges. I will describe the research that lead to the creation, implementation and evaluation of an inter-professional model of care and associated outcomes...
2016: Healthcare Quarterly
Kerry Kuluski, Allie Peckham, A Paul Williams, Ross E G Upshur
Person-centred care is becoming a key component of quality in health systems worldwide. Although the term can mean different things, it typically entails paying attention to the needs and background of health system users, involving them in decisions that affect their health, assessing their care goals and implementing a coordinated plan of care that aligns with their unique circumstances. The importance of practising a person-centred approach in care delivery dominates policy and research rhetoric worldwide, yet competing goals set by policy planners to save money, eliminate waste and sustain the healthcare system challenge the implementation of such an approach...
2016: Healthcare Quarterly
Renee Lyons
No abstract text is available yet for this article.
2016: Healthcare Quarterly
Christina Lawand, Geoff Paltser, Grace Cheung, Alison Ytsma
Good primary care is essential for the effective management of patients with chronic conditions in the community and to ensure their care is well coordinated with other parts of the system. The Commonwealth Fund 2015 International Health Policy Survey compares the views and experiences of primary care physicians in 11 countries including Canada. The survey found nearly all (98%) primary care doctors across countries treat patients with complex needs in their practice. However, when examining questions on chronic disease management and coordination of care with other providers, Canadian results are mixed compared to the international average, and show variation at the provincial level...
2016: Healthcare Quarterly
Kyla L Naylor, Amit X Garg, S Joseph Kim, Gregory A Knoll
Fractures are associated with morbidity and mortality. Individuals with chronic kidney disease (CKD) experience bone mineral metabolism changes, which increases fracture risk. Researchers have quantified the epidemiology of fractures in adults with CKD using administrative health databases from Ontario, Canada, held at the Institute for Clinical Evaluative Sciences. Results demonstrated that many individuals with non-transplant CKD sustain fractures, with the risk increasing as kidney function declines. However, fracture risk in kidney transplant recipients was lower than previously described, which suggests recipients may not be a high-risk fracture group...
2016: Healthcare Quarterly
(no author information available yet)
No abstract text is available yet for this article.
2016: Healthcare Quarterly
Danielle Bender, Paul Holyoke
It is now more important than ever for person- and family-centred care (PFCC) to be at the forefront of program and service design and delivery; yet, to date, very little guidance is available to assist home, community and long-term care (LTC) organizations to operationalize this concept and overcome inherent challenges. This article provides a list of practical strategies for healthcare leaders to promote and support a culture shift towards PFCC in their organizations and identifies and addresses five common concerns...
2016: Healthcare Quarterly
Kathleen Klaasen, Susan Bowman, Paul Komenda
This project developed an evaluation platform aimed at diagnosing team functioning using evidence-informed, measurable indicators to provide an actionable roadmap to guide teams in improving their interprofessional collaborative team performance. A scoping literature review, stakeholder consultation, survey and focus groups were conducted to inform both the final selection of eight indicators of effective, high-performing teams and the process to assess and evaluate teams against these indicators. The program was piloted with two interprofessional teams in the Winnipeg Health Region...
2016: Healthcare Quarterly
Michael Heenan, Ted Rogovein, Elizabeth Buller, Anthony Plati
In 2012, publicly released reports indicated that the health outcomes at St. Joseph's Health Centre, Toronto (SJHC), may not be of the same quality when compared with those at peer hospitals. This surprised the leaders within the organization given that SJHC had a sound reputation for quality and patient safety within the sector. As a result, SJHC's senior management and medical leadership identified clinical outcomes and data quality as items to be addressed within its enterprise risk management framework with a focus on the methods by which data were collected, coded and used by clinicians...
2016: Healthcare Quarterly
Karen Ho, Randi Zlotnik Shaul, Lee Ann Chapman, Elizabeth Lee Ford-Jones
In pediatric healthcare, there is a recognized need to address social determinants of health (SDOH) to positively influence child health and development. In addition, family-centred care (FCC) recognizes the value of the family unit in affecting individual patient experiences of illness and care. However, pediatric healthcare that incorporates principles of FCC and SDOH may be interpreted as calling on clinicians to deviate from or add to practices that form an accepted standard of care. This paper explores the legal and ethical considerations of doing so and describes practical responses to these challenging situations...
2016: Healthcare Quarterly
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