HealthcarePapers
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The Mazankowski committee considered all too familiar problems with the Alberta healthcare system, in particular expenditure inflation and public "affordability," and the efficiency of the provision of care to the population. The remedies if offers are incomplete and unconvincing because of the failure to use rigorously the evidence base. ⋯ Investment in these areas together with global budgets and equitable financial allocations offers better health for the Alberta population. Many of the Council's proposals are not consistent with the goals of expenditure control, equity and efficiency.
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Comment Review
Managing healthcare costs within an integrated framework.
Laupacis, Anderson and O'Brien's comprehensive diagnosis of the illness affecting the Canadian healthcare system is very insightful. In addition, their call for improving the quality of drug evidence and outcomes is a laudable goal. However, their prognosis of the negative impact on healthcare due to escalating drug costs appears to be rather pessimistic, as they fail to view drugs within an integrated framework. ⋯ The authors' goal-oriented concept of creating a clinical milieu that encourages cost-effective prescribing via "optimum" drug use is very attractive. One such approach is Disease Management, which relies on evidence-based, outcome-oriented performance indicators. It is highly regarded for promoting effective treatment options, improving patient care and optimizing healthcare resource utilization--hence deserving serious consideration for reducing overall costs while achieving improved outcomes.
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Academic health sciences centres in both the United States and Canada, once major "brokers" of medical and biomedical knowledge and other scare resources, are frequently depicted as "victims" of the environments in which they exist. While the national and local environments in which these organizations exist differ substantially, the integrity of AHSCs in both nations is threatened by a variety of emergent and continuing externalities. It is important that AHSCs develop a sufficient vision and market to be self-determining and successful in countering pressures that challenge their teaching, research and service activities. Leadership in both Canada and the United States must become much more skilled in strategic management to achieve this goal.
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Review Case Reports
Making patients safer! Reducing error in Canadian healthcare.
Media reports of adverse events experienced by patients raise questions about whether these are isolated exceptions or part of a larger problem. There is no reliable Canadian data on medical error; but there is little reason to expect that the situation differs markedly from Australia or the United States which have rigorously studied the problem. Research in Australia has concluded that as many as 16% of hospital patients are injured as a result of their treatment. ⋯ These cultures will require a new emphasis on teamwork, a continual focus on redesigning care systems, particularly in high risk areas such as operating rooms, intensive care units and emergency rooms. These are not easy tasks and will require investments in new equipment and new skills. These steps are essential if we are to maintain public confidence in healthcare.
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Clinicians must celebrate and study medical errors. The dark culture of blame must be replaced by a scholarly culture of safety. This commentary presents six cases that show what we can learn from errors. ⋯ Clinicians will find it difficult to undertake major safety initiatives given the existing constraints on time and energy. Although clinicians can identify the safety problems,there must also be a commitment to understand safety problems and make improvements. It is strongly recommended that hospitals train, implement and support Patient Safety Consultation Teams.