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.
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.
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.
Cites: Health Technol Assess. 2001;5(12):1-7911319991
Cites: N Engl J Med. 2005 Mar 3;352(9):857-915745974
Cites: Health Policy. 2005 Jul;73(1):10-2015911053
Cites: Int J Technol Assess Health Care. 2005 Spring;21(2):219-2715921062
Cites: BMJ. 2006 Jan 14;332(7533):112-416410591
Cites: Health Policy. 2007 Mar;80(3):444-5816757057
Cites: Am J Surg. 2002 Apr;183(4):399-40511975927
Cites: J Am Coll Surg. 2003 Jul;197(1):64-7012831926
Cites: World J Surg. 2003 Aug;27(8):962-612784149
Cites: World J Surg. 2003 Aug;27(8):930-4; discussion 934-512822049
Cites: J Health Serv Res Policy. 2003 Oct;8(4):197-20114596753
Cites: Ann Surg. 2003 Dec;238(6 Suppl):S56-6614703746
Cites: J Neurosurg. 2004 Jan;100(1):2-714743905
Cites: J Infect Dis. 2004 Mar 1;189(5):930-714976611
Cites: J Neurosurg. 1979 Jul;51(1):5-11376786
Cites: Int J Technol Assess Health Care. 1985;1(3):669-8010276734
Cites: J Vasc Surg. 1996 Feb;23(2):191-2008637096
Cites: World J Surg. 1996 Jul-Aug;20(6):687-918662153
Cites: J Gen Intern Med. 1996 May;11(5):294-3028725978
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.
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.
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.
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.