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Access to palliative care services in hospital: a matter of being in the right hospital. Hospital charts study in a Canadian city.

https://arctichealth.org/en/permalink/ahliterature133654
Source
Palliat Med. 2012 Jan;26(1):89-94
Publication Type
Article
Date
Jan-2012
Author
Joachim Cohen
Donna M Wilson
Amy Thurston
Rod MacLeod
Luc Deliens
Author Affiliation
Ghent University & Vrije Universiteit Brussel, End-of-Life Care Research Group, Brussels, Belgium. jcohen@vub.ac.be
Source
Palliat Med. 2012 Jan;26(1):89-94
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Child
Child, Preschool
Female
Health Services Accessibility - standards
Health Services Research
Hospital Planning
Hospitals, Urban - organization & administration
Humans
Infant
Male
Medical Records
Middle Aged
Palliative Care - organization & administration - standards
Referral and Consultation - standards
Young Adult
Abstract
Access to palliative care (PC) is a major need worldwide. Using hospital charts of all patients who died over one year (April 2008-March 2009) in two mid-sized hospitals of a large Canadian city, similar in size and function and operated by the same administrative group, this study examined which patients who could benefit from PC services actually received these services and which ones did not, and compared their care characteristics. A significantly lower proportion (29%) of patients dying in hospital 2 (without a PC unit and reliant on a visiting PC team) was referred to PC services as compared to in hospital 1 (with a PC unit; 68%). This lower referral likelihood was found for all patient groups, even among cancer patients, and remained after controlling for patient mix. Referral was strongly associated with having cancer and younger age. Referral to PC thus seems to depend, at least in part, on the coincidence of being admitted to the right hospital. This finding suggests that establishing PC units or a team of committed PC providers in every hospital could increase referral rates and equity of access to PC services. The relatively lower access for older and non-cancer patients and technology use in hospital PC services require further attention.
PubMed ID
21680750 View in PubMed
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Achieving clinical improvement: an interdisciplinary intervention.

https://arctichealth.org/en/permalink/ahliterature187771
Source
Health Care Manage Rev. 2002;27(4):42-56
Publication Type
Article
Date
2002
Author
Diane M Irvine Doran
G Ross Baker
Michael Murray
John Bohnen
Catherine Zahn
Souraya Sidani
Jennifer Carryer
Author Affiliation
Faculty of Nursing, University of Toronto, Ontario.
Source
Health Care Manage Rev. 2002;27(4):42-56
Date
2002
Language
English
Publication Type
Article
Keywords
Clinical Competence
Group Processes
Health Services Research
Hospitals, Urban - organization & administration - standards
Humans
Interprofessional Relations
Ontario
Outcome and Process Assessment (Health Care)
Patient Care Team - standards
Problem Solving
Staff Development
Total Quality Management
Abstract
This study evaluates whether training health care teams in continuous quality improvement methods results in improvements in the care of and outcomes for patients. Nine of the 25 teams who participated in the study were successful in improving the care/outcomes for patients. Successful teams were more effective at problem solving, engaged in more functional group interactions, and were more likely to have physician participation.
PubMed ID
12433246 View in PubMed
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Adoption of an innovation to repair aortic aneurysms at a Canadian hospital: a qualitative case study and evaluation.

https://arctichealth.org/en/permalink/ahliterature160317
Source
BMC Health Serv Res. 2007;7:182
Publication Type
Article
Date
2007
Author
Nathalie M Danjoux
Douglas K Martin
Pascale N Lehoux
Julie L Harnish
Randi Zlotnik Shaul
Mark Bernstein
David R Urbach
Author Affiliation
Department of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Canada. nathalie.danjoux@utoronto.ca
Source
BMC Health Serv Res. 2007;7:182
Date
2007
Language
English
Publication Type
Article
Keywords
Academic Medical Centers - organization & administration
Aortic Aneurysm, Abdominal - surgery
Blood Vessel Prosthesis Implantation - methods - utilization
Decision Making, Organizational
Diffusion of Innovation
Hospitals, Urban - organization & administration
Humans
Ontario
Organizational Case Studies
Organizational Innovation
Qualitative Research
Vascular Surgical Procedures - methods - utilization
Abstract
Priority setting in health care is a challenge because demand for services exceeds available resources. The increasing demand for less invasive surgical procedures by patients, health care institutions and industry, places added pressure on surgeons to acquire the appropriate skills to adopt innovative procedures. Such innovations are often initiated and introduced by surgeons in the hospital setting. Decision-making processes for the adoption of surgical innovations in hospitals have not been well studied and a standard process for their introduction does not exist. The purpose of this study is to describe and evaluate the decision-making process for the adoption of a new technology for repair of abdominal aortic aneurysms (endovascular aneurysm repair [EVAR]) in an academic health sciences centre to better understand how decisions are made for the introduction of surgical innovations at the hospital level.
A qualitative case study of the decision to adopt EVAR was conducted using a modified thematic analysis of documents and semi-structured interviews. Accountability for Reasonableness was used as a conceptual framework for fairness in priority setting processes in health care organizations.
There were two key decisions regarding EVAR: the decision to adopt the new technology in the hospital and the decision to stop hospital funding. The decision to adopt EVAR was based on perceived improved patient outcomes, safety, and the surgeons' desire to innovate. This decision involved very few stakeholders. The decision to stop funding of EVAR involved all key players and was based on criteria apparent to all those involved, including cost, evidence and hospital priorities. Limited internal communications were made prior to adopting the technology. There was no formal means to appeal the decisions made.
The analysis yielded recommendations for improving future decisions about the adoption of surgical innovations. ese empirical findings will be used with other case studies to help develop guidelines to help decision-makers adopt surgical innovations in Canadian hospitals.
Notes
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PubMed ID
18005409 View in PubMed
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An assessment of the potential for repatriating care from urban to rural Manitoba.

https://arctichealth.org/en/permalink/ahliterature201458
Source
Med Care. 1999 Jun;37(6 Suppl):JS167-86
Publication Type
Article
Date
Jun-1999
Author
C. Black
C. Burchill
Author Affiliation
Manitoba Centre for Health Policy and Evaluation, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Source
Med Care. 1999 Jun;37(6 Suppl):JS167-86
Date
Jun-1999
Language
English
Publication Type
Article
Keywords
Adult
Benchmarking
Community Health Planning
Feasibility Studies
Health Facility Closure
Health Policy
Health Services Accessibility
Hospital Planning - organization & administration
Hospitals, Rural - utilization
Hospitals, Urban - organization & administration
Humans
Manitoba
Needs Assessment - organization & administration
Sensitivity and specificity
Abstract
Following the closure of Manitoba hospital beds, the Manitoba government adopted a strategy of shifting hospital care from more expensive urban hospitals to less expensive rural facilities. With this project, Manitoba Centre for Health Policy and Evaluation (MCHPE) studied the implications of the stated policy of "repatriation."
The project first involved examining population-based patterns of hospital utilization to define hospital service areas for 10 large rural hospitals. Three different hospital service area definitions were developed for use in sensitivity testing. Rates of overall use of hospital services, indicators of need for health care, and patterns of use of urban facilities are compared for these hospital service areas. Using a large rural hospital as a benchmark, patterns of adult surgical, adult medical, pediatric, and obstetric care were examined for the hospital service areas. Number and percent of cases provided by the index hospital and by urban hospitals were compared, to assess the feasibility and the potential impact of redirection of care to the benchmark level.
Although in theory a significant percentage of care delivered to rural residents by Winnipeg hospitals might be redirected to rural institutions, the project raised issues of feasibility. Moreover, it identified that most of the redirected cases could be accommodated within existing capacity.
PubMed ID
10409008 View in PubMed
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Career satisfaction among general surgeons in Canada: a qualitative study of enablers and barriers to improve recruitment and retention in general surgery.

https://arctichealth.org/en/permalink/ahliterature120301
Source
Acad Med. 2012 Nov;87(11):1616-21
Publication Type
Article
Date
Nov-2012
Author
Najma Ahmed
Lesley Gotlib Conn
Mary Chiu
Bochra Korabi
Adnan Qureshi
Avery B Nathens
Simon Kitto
Author Affiliation
Department of Surgery, Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. ahmedn@smh.ca
Source
Acad Med. 2012 Nov;87(11):1616-21
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Cooperative Behavior
Cross-Cultural Comparison
General Surgery - manpower
Hospital Administrators
Hospitals, Rural - organization & administration
Hospitals, Urban - organization & administration
Humans
Interdisciplinary Communication
Interprofessional Relations
Job Satisfaction
Medically underserved area
Personnel Selection - organization & administration
Personnel Turnover
Physician-Patient Relations
Professional Autonomy
Social Support
Work Schedule Tolerance
Abstract
To understand what influences career satisfaction among general surgeons in urban and rural areas in Canada in order to improve recruitment and retention in general surgery.
Semistructured interviews were conducted with 32 general surgeons in 2010 who were members of the Canadian Association of General Surgeons and who currently practice in either an urban or rural area. Interviews explored factors contributing to career satisfaction, as well as suggestions for preventive, screening, or management strategies to support general surgery practice.
Findings revealed that both urban and rural general surgeons experienced the most satisfaction from their ability to resolve patient problems quickly and effectively, enhancing their sense of the meaningfulness of their clinical practice. The supportive relationships with colleagues, trainees, and patients was also cited as a key source of career satisfaction. Conversely, insufficient access to resources and a perceived disconnect between hospital administration and clinical practice priorities were raised as key "systems-level" problems. As a result, many participants felt alienated from their work by these systems-level barriers that were perceived to hinder the provision of high-quality patient care.
Career satisfaction among both urban and rural general surgeons was influenced positively by the social aspects of their work, such as patient and colleague relationships, as well as a perception of an increasing amount of control and autonomy over their professional commitments. The modern general surgeon values a balance between professional obligations and personal time that may be difficult to achieve given the current system constraints.
PubMed ID
23018322 View in PubMed
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[Current issues in municipal health services].

https://arctichealth.org/en/permalink/ahliterature183528
Source
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2003 Jul-Aug;(4):25-7
Publication Type
Article
Author
O P Shchepin
Iu G Tregubov
E A Aslanian
S I Isaenko
S S Rytvinskii
Source
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2003 Jul-Aug;(4):25-7
Language
Russian
Publication Type
Article
Keywords
Catchment Area (Health)
Health Services Needs and Demand - trends
Hospital Bed Capacity
Hospitals, Rural - organization & administration - supply & distribution - utilization
Hospitals, Urban - organization & administration - supply & distribution - utilization
Humans
Morbidity - trends
Russia - epidemiology
Abstract
A study, held in the Krasnodar Territory in 1994-2002, showed an increasing morbidity in residents of all age-categories. Essential differences in the prevalence of registered pathologies and in the nature of their dynamics were registered in some districts. An optimized structure of hospital beds resulted, in the above Territory, in a reduced quantity of beds, primarily in rural areas, and in their more effective utilization. More rural citizens applied for medical care to urban and territorial patient-care facilities, by 1.5 and 1.4 times respectively. Such reduction of hospital beds is possible only after advancing appropriately the regular medical check-ups and clinical care and after diminishing the need in the treatment of patients at hospitals. The data of sociological questioning of residents and of doctors held in three municipal entities by using the method of monitoring are presented. It was demonstrated that promotion of inter-district diagnostic centers, priority development of regular medical check-ups and purpose-oriented measures of reprofiling the specialized bed funds are topical issues in promoting the municipal medical care.
PubMed ID
14513496 View in PubMed
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[Current principles in the organization of emergency surgical care in a large city].

https://arctichealth.org/en/permalink/ahliterature181299
Source
Vestn Khir Im I I Grek. 2003;162(6):89-91
Publication Type
Article
Date
2003
Author
V V Arkhipov
S F Bagnenko
V F Ozerov
Source
Vestn Khir Im I I Grek. 2003;162(6):89-91
Date
2003
Language
Russian
Publication Type
Article
Keywords
Emergency Service, Hospital - organization & administration
Hospital Planning
Hospitals, Urban - organization & administration
Humans
Russia
Surgery Department, Hospital - organization & administration
Abstract
The specific character of emergency surgical care requires a concentration of highly skilled specialists of various profiles on the basis of multi-type hospitals and using expensive modern, highly informative and less invasive methods of diagnosis and treatment. The using of multi-type hospitals for emergency medical care will allow the intensification of treatment, wide application of less invasive technologies that will result in the appearance of incentives and conditions to shorten the number of bed-days, restriction of groundless hospitalization and to improve the tariff politics in the system of compulsory medical insurance.
PubMed ID
14997827 View in PubMed
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53 records – page 1 of 6.