HealthcarePapers
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Hutchison makes a number of important observations about primary healthcare renewal in Canada. This commentary on his paper examines some of the forces driving policy change in primary health, particularly concerns about increasing demand. While I agree with Hutchison that incremental change is more likely than radical reform, I argue that it may be time to fundamentally rethink the role of primary healthcare.
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The Canadian Institute for Health Information began publishing hospital standardized mortality ratio (HSMR) data for select Canadian hospitals in November 2007. This paper describes the experience of the Winnipeg Regional Health Authority in assessing the validity of the HSMR through statistical analysis, coding definitions and chart audits. We found a lack of empirical evidence supporting the use of the HSMR in measuring reductions in preventable deaths. ⋯ The results of our chart audit show that the HSMR is not a sensitive measure of adverse events as defined by "unexpected death" in the Canadian Adverse Events Study. It should not be viewed as an important indicator of patient safety or quality of care. We discuss the cumulative sum statistic as an alternative to the HSMR in monitoring in-hospital mortality.
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Solving the obesity crisis has less to do with post-partisanship and more to do with increasing public support for strong public policy initiatives that will make the healthy choice the easy choice. The government has an important role in mitigating the toxic food environment created by food manufacturers and restaurant chains. Progress to date has occurred on the state level. With greater public support in a new political environment, national progress may be possible in the foreseeable future.
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Following decades of stagnation, potentially transformative changes in primary healthcare are proceeding in several Canadian provinces. These changes - primarily collaborative and interdisciplinary models of care delivery and quality improvement programs - have been impelled by an improved fiscal climate, increased federal transfers (some earmarked for primary healthcare), pressure generated by the recommendations of the Romanow Commission and the Kirby Committee and growing political and public concern about healthcare access and quality. ⋯ Processes are needed at the regional and provincial levels to collectively engage the full range of key stakeholders in providing policy advice and informing the articulation of clear policy direction for primary healthcare. Critical areas for investment include integrated health information systems, quality improvement processes, interdisciplinary primary healthcare teams and group practices, and systematic evaluation of primary healthcare innovations and ongoing system performance.
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Comment
Enabling quality improvement within primary healthcare through the CCHSA accreditation program.
Progress is being made on the journey to strengthen primary healthcare within Canada. As an essential component of the healthcare continuum, primary healthcare must be more effectively linked and its role optimized for better patient/client outcomes to be realized. ⋯ Since that time, accreditation standards have been established across a wide range of healthcare sectors and specialty areas. CCHSA's accreditation program will increasingly contribute to strengthening the essential and integral role of primary healthcare in the healthcare system.