Skip header and navigation

Refine By

47 records – page 1 of 5.

Access to adult liver transplantation in Canada: a survey and ethical analysis.

https://arctichealth.org/en/permalink/ahliterature212821
Source
CMAJ. 1996 Feb 1;154(3):337-42
Publication Type
Article
Date
Feb-1-1996
Author
M A Mullen
N. Kohut
M. Sam
L. Blendis
P A Singer
Author Affiliation
University of Toronto Joint Centre for Bioethics, Ont.
Source
CMAJ. 1996 Feb 1;154(3):337-42
Date
Feb-1-1996
Language
English
Publication Type
Article
Keywords
Adult
Canada
Data Collection
Health Care Rationing - organization & administration
Health Services Accessibility - organization & administration
Humans
Liver Transplantation
Organizational Policy
Patient Selection
Resource Allocation
Waiting Lists
Abstract
To describe the substantive and procedural criteria used for placing patients on the waiting list for liver transplantation and for allocating available livers to patients on the waiting list; to identify principal decision-makers and the main factors limiting liver transplantation in Canada; and to examine how closely cadaveric liver allocation resembles theoretic models of source allocation.
Mailed survey.
Medical directors of all seven Canadian adult liver transplantation centres, or their designates. Six of the questionnaires were completed.
Relative importance of substantive and procedural criteria used to place patients in the waiting list for liver transplantation and to allocate available livers. Identification of principal decision-makers and main limiting factors to adult liver transplantation.
Alcoholism, drug addiction, HIV positivity, primary liver cancer, noncompliance and hepatitis B were the most important criteria that had a negative influence on decisions to place patients on the waiting list for liver transplantation. Severity of disease and urgency were the most important criteria used for selecting patients on the waiting list for transplantation. Criteria that were inconsistent across the centres included social support (for deciding who is placed on the waiting list) and length of time on the waiting list (for deciding who is selected from the list). Although a variety of people were reported as being involved in these decisions, virtually all were reported to be health to be health care professionals. Thirty-seven patients died while waiting for liver transplantation in 1991; the scarcity of cadaveric livers was the main limiting factor.
Criteria for resource allocation decisions regarding liver transplantation are generally consistent among the centres across Canada, although some important inconsistencies remain. Because patients die while on the waiting list and because the primary limiting factor is organ supply, increased organ acquisition efforts are needed.
Notes
Cites: Psychosomatics. 1993 Jul-Aug;34(4):314-238351306
Cites: Arch Intern Med. 1990 Mar;150(3):523-72178581
Cites: BMJ. 1990 Jul 7;301(6742):15-72383700
Cites: N Engl J Med. 1991 Oct 24;325(17):1243-61845039
PubMed ID
8564903 View in PubMed
Less detail

Allocating limited resources in a time of fiscal constraints: a priority setting case study from Dalhousie University Faculty of Medicine.

https://arctichealth.org/en/permalink/ahliterature113649
Source
Acad Med. 2013 Jul;88(7):939-45
Publication Type
Article
Date
Jul-2013
Author
Craig Mitton
Adrian Levy
Diane Gorsky
Christina MacNeil
Francois Dionne
Tom Marrie
Author Affiliation
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada. craig.mitton@ubc.ca
Source
Acad Med. 2013 Jul;88(7):939-45
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Budgets - organization & administration
Decision Making
Faculty, Medical
Health Care Rationing - organization & administration
Humans
Models, organizational
Nova Scotia
Organizational Case Studies
Public Sector - economics
Resource Allocation - organization & administration
Schools, Medical - economics
Abstract
Facing a projected $1.4M deficit on a $35M operating budget for fiscal year 2011/2012, members of the Dalhousie University Faculty of Medicine developed and implemented an explicit, transparent, criteria-based priority setting process for resource reallocation. A task group that included representatives from across the Faculty of Medicine used a program budgeting and marginal analysis (PBMA) framework, which provided an alternative to the typical public-sector approaches to addressing a budget deficit of across-the-board spending cuts and political negotiation. Key steps to the PBMA process included training staff members and department heads on priority setting and resource reallocation, establishing process guidelines to meet immediate and longer-term fiscal needs, developing a reporting structure and forming key working groups, creating assessment criteria to guide resource reallocation decisions, assessing disinvestment proposals from all departments, and providing proposal implementation recommendations to the dean. All departments were required to submit proposals for consideration. The task group approved 27 service reduction proposals and 28 efficiency gains proposals, totaling approximately $2.7M in savings across two years. During this process, the task group faced a number of challenges, including a tight timeline for development and implementation (January to April 2011), a culture that historically supported decentralized planning, at times competing interests (e.g., research versus teaching objectives), and reductions in overall health care and postsecondary education government funding. Overall, faculty and staff preferred the PBMA approach to previous practices. Other institutions should use this example to set priorities in times of fiscal constraints.
PubMed ID
23702521 View in PubMed
Less detail

Allocation of home care services by municipalities in Norway: a document analysis.

https://arctichealth.org/en/permalink/ahliterature291433
Source
BMC Health Serv Res. 2017 Sep 22; 17(1):673
Publication Type
Journal Article
Multicenter Study
Date
Sep-22-2017
Author
Solrun G Holm
Terje A Mathisen
Torill M Sæterstrand
Berit S Brinchmann
Author Affiliation
Faculty of Nursing and Health Sciences, Nord University, Storgt 105, 8370, Leknes, Norway. solrun.holm@nord.no.
Source
BMC Health Serv Res. 2017 Sep 22; 17(1):673
Date
Sep-22-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Keywords
Aged, 80 and over
Cities - statistics & numerical data
Delivery of Health Care - standards
Female
Health Care Rationing - organization & administration
Health Services for the Aged - supply & distribution
Home Care Services - supply & distribution
House Calls - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Male
Norway
Residence Characteristics - statistics & numerical data
Retrospective Studies
Social Support
Abstract
In Norway, elder care is primarily a municipal responsibility. Municipal health services strive to offer the 'lowest level of effective care,' and home healthcare services are defined as the lowest level of care in Norway. Municipalities determine the type(s) of service and the amount of care applicants require. The services granted are outlined in an individual decision letter, which serves as a contract between the municipality and the home healthcare recipient. The purpose of this study was to gain insight into the scope and duration of home healthcare services allocated by municipalities and to determine where home care recipients live in relation to home healthcare service offices.
A document analysis was performed on data derived from 833 letters to individuals allocated home care services in two municipalities in Northern Norway (Municipality A = 500 recipients, Municipality B = 333 recipients).
In Municipality A, 74% of service hours were allotted to home health nursing, 12% to practical assistance, and 14% to support contact; in Municipality B, the distribution was 73%, 19%, and 8%, respectively. Both municipalities allocated home health services with no service end date (41% and 85% of the total services, respectively). Among recipients of "expired" services, 25% in Municipality A and 7% in Municipality B continued to receive assistance.
Our findings reveal that the municipalities adhered to the goal for home care recipients to remain at home as long as possible before moving into a nursing home. The findings also indicate that the system for allocating home healthcare services may not be fair, as the municipalities lacked procedures for revising individual decisions. Our findings indicate that local authorities should closely examine how they design individual decisions and increase their awareness of how long a service should be provided.
Notes
Cites: BMC Health Serv Res. 2014 Sep 26;14:439 PMID 25258004
Cites: Br J Community Nurs. 2010 Oct;15(10):497-502 PMID 20966846
Cites: Scand J Caring Sci. 2015 Jun;29(2):317-24 PMID 25308748
Cites: Sociol Health Illn. 2016 Jan;38(1):109-22 PMID 26474802
Cites: J Clin Nurs. 2010 Jan;19(1-2):100-8 PMID 20500248
Cites: Policy Polit Nurs Pract. 2009 Nov;10(4):276-84 PMID 20164066
Cites: Health Econ Rev. 2016 Dec;6(1):8 PMID 26914355
Cites: Health Soc Care Community. 2016 Jul;24(4):399-410 PMID 25728063
Cites: Soc Sci Med. 2013 Aug;91:194-201 PMID 22944147
Cites: J Aging Soc Policy. 2016 Oct-Dec;28(4):277-91 PMID 26959294
Cites: J Epidemiol Community Health. 2016 Aug;70(8):771-7 PMID 26896519
Cites: Br J Community Nurs. 2011 Jul;16(7):342-6 PMID 21727793
Cites: Comput Inform Nurs. 2012 Jun;30(6):300-11 PMID 22411417
PubMed ID
28938892 View in PubMed
Less detail

An evaluation of strategies to reduce waiting times for total joint replacement in Ontario.

https://arctichealth.org/en/permalink/ahliterature154539
Source
Med Care. 2008 Nov;46(11):1177-83
Publication Type
Article
Date
Nov-2008
Author
Lauren E Cipriano
Bert M Chesworth
Chris K Anderson
Gregory S Zaric
Author Affiliation
Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA.
Source
Med Care. 2008 Nov;46(11):1177-83
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
Arthroplasty, Replacement - statistics & numerical data
Computer simulation
Health Care Rationing - organization & administration - statistics & numerical data
Health Planning - organization & administration - statistics & numerical data
Health Priorities - organization & administration - statistics & numerical data
Humans
National Health Programs - organization & administration - statistics & numerical data
Needs Assessment
Ontario
Patient Selection
Waiting Lists
Abstract
In 2005, the median waiting time for total hip and knee joint replacements in Ontario was greater than 6 months, which is considered longer than clinically appropriate. Demand is expected to increase and exacerbate already long waiting times. Solutions are needed to reduce waiting times and improve waiting list management.
We developed a discrete event simulation model of the Ontario total joint replacement system to evaluate the effects of 4 management strategies on waiting times: (1) reductions in surgical demand; (2) formal clinical prioritization; (3) waiting time guarantees; and (4) common waiting list management.
If the number of surgeries performed increases by less than 10% each year, then demand must be reduced by at least 15% to ensure that, within 10 years, 90% of patients receive surgery within their maximum recommended waiting time. Clinically prioritizing patients reduced waiting times for high-priority patients and increased the number of patients at all priority levels who received surgery each year within recommended maximum waiting times by 9.3%. A waiting time guarantee for all patients provided fewer surgeries within recommended waiting times. Common waiting list management improved efficiency and increased equity in waiting across regions.
Dramatically increasing the supply of joint replacement surgeries or diverting demand for surgeries to other jurisdictions will reduce waiting times for total joint replacement surgery. Introducing a strictly adhered to patient prioritization scheme will ensure that more patients receive surgery within severity-specific waiting time targets. Implementing a waiting time guarantee for all patients will not reduce waiting times--it will only shuffle waiting times from some patients to others. To reduce waiting times to clinically acceptable levels within 10 years, increases in the number of surgeries provided greater than those observed historically or reductions in demand are needed.
PubMed ID
18953229 View in PubMed
Less detail

[An orthopedic surgeon's views on waiting lists: structure rationalization for efficiency].

https://arctichealth.org/en/permalink/ahliterature225396
Source
Lakartidningen. 1991 Nov 13;88(46):3892-4
Publication Type
Article
Date
Nov-13-1991
Author
K G Thorngren
Author Affiliation
Ortopediska kliniken, Lasarettet i Lund.
Source
Lakartidningen. 1991 Nov 13;88(46):3892-4
Date
Nov-13-1991
Language
Swedish
Publication Type
Article
Keywords
Efficiency
Finland
Health Care Rationing - organization & administration
Health services needs and demand
Humans
Orthopedics - education - organization & administration - standards
Sweden
Waiting Lists
Workload
PubMed ID
1956216 View in PubMed
Less detail

Applying a prism: the spectrum of a sustainable healthcare system.

https://arctichealth.org/en/permalink/ahliterature162798
Source
Healthc Pap. 2007;7(4):34-8; discussion 68-70
Publication Type
Article
Date
2007
Author
Catherine Zahn
Author Affiliation
University Health Network, Department of Medicine, University of Toronto.
Source
Healthc Pap. 2007;7(4):34-8; discussion 68-70
Date
2007
Language
English
Publication Type
Article
Keywords
Canada
Chronic Disease - economics - prevention & control - therapy
Disease Management
Efficiency, Organizational
Health Care Rationing - organization & administration
Health Services Accessibility - economics - organization & administration
Health services needs and demand
Humans
National Health Programs - economics - organization & administration
Primary Health Care - organization & administration
Quality of Health Care - organization & administration
Waiting Lists
Abstract
Initiatives aimed at reducing wait times for surgical and diagnostic procedures and comprehensive chronic disease management programs focus, respectively, on the supply and demand aspects of access to healthcare. Addressing either in isolation can have a salutary health effect for segments of the population and produce system improvement. Approaching healthcare access issues even more broadly, in the context of population health and with a patient-centred perspective, carries the promise of sustainability, the potential for superior health outcomes across a continuum of patient care and the possibility of enhanced system competency through true integration of multiple sectors. A model for comprehensive access to health services includes a plan for a network of primary care providers, appropriate capacity and flow efficiency for the provision of unplanned (emergency) services, operationalization of wait times initiatives to sustain planned services (most surgeries and diagnostic procedures) and a strategy for decreasing demand for care by engaging primary and community care capabilities and a robust chronic disease management strategy.
Notes
Comment On: Healthc Pap. 2007;7(4):6-2317595546
PubMed ID
17595549 View in PubMed
Less detail

Cardiac rehabilitation services in Ontario: components, models and underserved groups.

https://arctichealth.org/en/permalink/ahliterature121697
Source
J Cardiovasc Med (Hagerstown). 2012 Nov;13(11):727-34
Publication Type
Article
Date
Nov-2012
Author
Peter A Polyzotis
Yongyao Tan
Peter L Prior
Paul Oh
Terry Fair
Sherry L Grace
Author Affiliation
York University, Faculty of Health, School of Kinesiology and Health Science, Toronto, Ontario, Canada.
Source
J Cardiovasc Med (Hagerstown). 2012 Nov;13(11):727-34
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Cardiology Service, Hospital - organization & administration
Cardiovascular Agents - therapeutic use
Community Health Services - organization & administration
Comorbidity
Cross-Sectional Studies
Delivery of Health Care, Integrated - organization & administration
Depression - diagnosis - epidemiology
Exercise Therapy - organization & administration
Guideline Adherence
Health Care Rationing - organization & administration
Health Care Surveys
Health Knowledge, Attitudes, Practice
Health Services Accessibility - organization & administration
Health Services Needs and Demand - organization & administration
Heart Diseases - epidemiology - rehabilitation
Home Care Services, Hospital-Based - organization & administration
Humans
Models, organizational
Ontario - epidemiology
Patient Education as Topic - organization & administration
Practice Guidelines as Topic
Questionnaires
Risk factors
Rural health services - organization & administration
Vulnerable Populations
Abstract
Cardiac rehabilitation programs develop in accordance with guidelines, but also in response to local needs and resources. This study evaluated features of Ontario cardiac rehabilitation programs in accordance with guidelines, emerging evidence and treating underserved populations.
In this cross-sectional study, all Ontario cardiac rehabilitation programs were mailed an investigator-generated survey. Responses were received from 38 of 45 (84.4%) programs.
Twenty-seven (71.1%) cardiac rehabilitation programs were located within a hospital. Twenty-four (63.2%) programs reported that they offer two sessions of exercise and education per week. Twenty-six (68.4%) programs offered an alternative model of program delivery other than on-site, with 10 (27.0%) programs reporting they tailored their programs to rural patients. Twenty-three (62.2%) programs provided services to patients with a noncardiac primary indication. Twenty-six (68.4%) programs systematically screened patients for depressive symptoms. Twenty-seven (71.1%) offered resources to patients postgraduation.
Most cardiac rehabilitation programs offered alternative models of care, such as home-based rehabilitation. Cardiac rehabilitation sites are well integrated within their community, enabling smooth postcardiac rehabilitation transitions for patients. Cardiac rehabilitation programs continue to offer proven comprehensive components, while simultaneously attempting to adapt to meet the needs of patients with other chronic diseases.
PubMed ID
22885529 View in PubMed
Less detail

Case study on priority setting in rural Southern Alberta: keeping the house from blowing in.

https://arctichealth.org/en/permalink/ahliterature176949
Source
Can J Rural Med. 2004;9(1):26-36
Publication Type
Article
Date
2004
Author
Lisa Halma
Craig Mitton
Cam Donaldson
Bruce West
Author Affiliation
Lethbridge Regional Hospital, 960 19th St. S, Lethbridge AB T1J 1W5.
Source
Can J Rural Med. 2004;9(1):26-36
Date
2004
Language
English
Publication Type
Article
Keywords
Alberta
Chronic Disease - therapy
Disease Management
Health Care Rationing - organization & administration
Health Priorities - organization & administration
Humans
Regional Health Planning - organization & administration
Rural Population
Abstract
This case study describes the priority-setting process undertaken by health care providers in the Municipal District of Taber, Alta., to improve and integrate chronic disease services within a fixed budget.
Providers first reviewed the current chronic disease management system, then considered alternatives based on program priorities and costs and benefits of potential changes.
Despite reaching consensus that a chronic disease clinic was the top priority for funding, providers were unable to redesign services accordingly. Redesign efforts were hampered by the groups' difficulty in identifying services that should receive fewer resources in order to fund priority areas, inexperience with priority-setting frameworks, group composition, the belief that many programs were already at "bare bone" funding levels, and perceptions of limited budget control. In the end, recommendations were made to use attrition to release resources, establish multi-disciplinary teams and group visits, where appropriate, and relocate providers to a centralized location. Upon review of study outcomes, Taber providers were granted more decision-making authority.
Overall, the use of a systematic priority-setting process, culminating in recommendations for action, has moved Taber providers closer to an integrated model of service delivery. It is recommended that formal priority-setting frameworks continue to be used in Taber for primary care renewal or at any level where consideration of existing evidence and projected costs is required.
PubMed ID
15603672 View in PubMed
Less detail

Chronic disease management: it's time for transformational change!

https://arctichealth.org/en/permalink/ahliterature162796
Source
Healthc Pap. 2007;7(4):43-7; discussion 68-70
Publication Type
Article
Date
2007
Author
Sarah C Muttitt
Richard C Alvarez
Author Affiliation
Innovation and Adoption, Canada Health Infoway.
Source
Healthc Pap. 2007;7(4):43-7; discussion 68-70
Date
2007
Language
English
Publication Type
Article
Keywords
Canada
Chronic Disease - economics - prevention & control - therapy
Disease Management
Health Care Rationing - organization & administration
Humans
Information Systems - economics - organization & administration
Medical Records Systems, Computerized - organization & administration
National Health Programs - economics - organization & administration
Practice Guidelines as Topic
Primary Health Care - organization & administration
Quality of Health Care - organization & administration
Abstract
The authors of the lead essay present a compelling case for the development and implementation of a national strategy on chronic disease prevention and management (CDPM). The literature demonstrates that the Chronic Care Model can improve quality and reduce costs. Substantial evidence supports the role of health information technologies such as electronic health records (EHRs) in achieving these goals. However, an interoperable pan-Canadian health infostructure does not exist; funding is required to establish this across the continuum of care. An investment of $350 per capita would provide a robust health technology platform to support a national CDPM strategy. Such an investment would deliver annual benefits of $6-$7.6 billion; this could be leveraged to support national healthcare priorities such as CDPM. EHRs will improve decisions about care, reduce system errors and increase efficiency. They will also improve our ability to measure, assess and manage care. We cannot run a high-performing health system without sound data. This was a key step to enabling progress on wait times management. Leadership is required if a national CDPM strategy is to become reality. The authors made a convincing case for the development of a national strategy; we need to turn their words into actionable events to gain necessary momentum.
Notes
Comment On: Healthc Pap. 2007;7(4):6-2317595546
PubMed ID
17595551 View in PubMed
Less detail

Chronic disease management: the primary care perspective.

https://arctichealth.org/en/permalink/ahliterature162800
Source
Healthc Pap. 2007;7(4):26-8; discussion 68-70
Publication Type
Article
Date
2007
Author
Pauline Bragaglia
Lewis O'Brien
Author Affiliation
Algoma Diabetes Education Centre, Member of the Health Promotion Initiatives Team, Group Health Centre.
Source
Healthc Pap. 2007;7(4):26-8; discussion 68-70
Date
2007
Language
English
Publication Type
Article
Keywords
Canada
Chronic Disease - economics - prevention & control - therapy
Disease Management
Health Care Rationing - organization & administration
Humans
National Health Programs - economics - organization & administration
Practice Guidelines as Topic
Primary Health Care - economics - organization & administration
Quality of Health Care - organization & administration
Abstract
This response to the essay is a "view from the trenches" by two doctors who have worked over 23 years at the Group Health Centre in Sault Ste. Marie, Ontario. We would agree wholeheartedly that reducing wait times for selected procedures will not transform our health system, although they are a start that does provide improved quality of life for a relatively small number of people. We have struggled with the care gap between known best practices and the reality of care provided, from the perspectives of both prevention and chronic disease management. This has resulted in an acute awareness of the need for an across-the-system, "bottom-up" approach to the prevention of disease and management of healthcare. Limited resources must be carefully leveraged in innovative ways if we are to eliminate this care gap, decrease morbidity and minimize expensive "rescue" procedures that make our system increasingly unaffordable.
Notes
Comment On: Healthc Pap. 2007;7(4):6-2317595546
PubMed ID
17595547 View in PubMed
Less detail

47 records – page 1 of 5.