HealthcarePapers
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In 2008, Canada spent $172 billion on healthcare, more than $5,000 for every man, woman and child in the country. Canada has one of the longer life expectancies in the Organisation for Economic Co-operation and Development and relatively low (and declining) amenable mortality rates. This suggests that the healthcare system is having some positive effect; but how well do we know what is "right" and what needs improvement? What do we get for the money we spend on healthcare? This paper proposes that there are some basic issues to address before these value-for-money questions can be answered. What do we value, or what do we want to achieve with our healthcare spending? Are we using inputs such as human resources well to provide services? Are we using services well to promote health? How would we know? The paper ends with a series of challenges to healthcare managers and decision-makers: to re-establish a broad information strategy, to include research as an integral part of healthcare delivery, to develop new data that can tell us something about outcomes of care and to articulate more formally objectives for the healthcare system.
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This commentary by Victorian Order of Nurses Canada, written in response to "Getting What We Pay For? The Value-for-Money Challenge," by McGrail, Zierler and Ip, answers four key questions about Canada's home and community care sector: (1) What are our objectives? (2) Where do we achieve good value now? (3) Where and why are we failing? and (4) What will help us do better? We conclude that although the home and community care sector offers great promise in meeting the evolving health and social needs of Canadians, it is not living up to its potential. We propose the development of a national, integrated approach to home and community care to help Canadians remain healthy and independent in their homes. This would represent a wise financial investment for governments and would contribute to the long-term health of Canadians.
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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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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.