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SPRING 2007

Leadership

CIHR Names Medical Savings Account Study a Milestone in Health Services Research
CIHR recently named a study by HPME’s Raisa Deber and University of Manitoba's Evelyn Forget and Leslie Roos as a milestone in health services research. The medical savings account study, which was published in the Canadian Medical Association Journal in 2002, stimulated widespread controversy in the public/private healthcare debate and has continuing relevance.

Medical savings accounts would provide a credit to individuals, allowing them to pay for their own medical care up to a set amount. The ceiling on the account is intended to provide an incentive for individuals to minimize unnecessary use of health services and reduce healthcare costs. The study by Deber and colleagues, however, suggests that medical savings accounts will not save money, may in fact increase the costs of healthcare, and will increase spending on healthier people. Well patients would have little incentive to reduce their healthcare use, while a reduction in use by the sickest patients might result in inadequate preventive care and early intervention, raising costs of care in the long-term. The full-text article is available from CMAJ: “Medical Savings Accounts: Will they reduce costs?”.


Research Highlights

Staffing in BC Long-Term Care Facilities
Nursing home residents are among the most vulnerable members of our communities. As the population ages, communities are facing increasing challenges to provide efficient, high quality care. In this new CIHR-funded study, investigators will examine how staffing levels, staffing expertise and facility ownership (not-for-profit vs. for-profit) affect the quality of care.

HPME’s Whitney Berta and colleagues will analyze changes in BC long-term care facilities from 1995-2005 using data collected by Statistics Canada. The study will explore whether a similar level of public funding provided to not-for-profit and for-profit facilities is associated with different levels of staff expertise and mixes of professional and non-professional staff. Higher levels of direct care provided by professional staff (e.g. registered nurses, nurse aides) have been associated with better care outcomes in US studies of long-term care. This study will provide valuable Canadian data and contribute to our understanding of the relationship between staffing, facility ownership, and quality of care.

Aging, Social Capital and Health Services Utilization
Seniors face a number of life transitions that put them at risk of social isolation and exclusion. Social capital – the networks of social relations that provide individuals and groups with access to resources and supports – may reduce isolation and facilitate healthy aging. This pilot study, funded by the CIHR Institute of Aging, will explore whether higher levels of social capital are associated with lower health care utilization among older people.

HPME’s Audrey Laporte and Eric Nauenberg will investigate whether number of physician visits varied with level of social capital in 2000-2001, as measured by a number of indicators including: religious observance (attendance at church services), social supports (membership in clubs, extended family, etc.), and feeling of connectedness to the community. While the concept of social capital has gained in popularity in academic and health policy circles, what it actually is and how it should be measured continue to be debated. This study will contribute to this debate and offer refined measures of individual- and community-level social capital.

Effects of Delisting Physical Therapy in Ontario
What happens when the Provincial government restricts the eligibility criteria for community-based physical therapy (PT) services? A recent publication co-authored by HPME's Raisa Deber, Susan Jaglal and Audrey Laporte, reports on the results of a study of this policy decision that took effect in Ontario in 2005 (Int J of Rehab Res, 2006;29:303-307).

Findings are based on interviews conducted before and after partial delisting with clients who had been assessed at one of 98 Ontario clinics. After delisting, 71.7% of clients who required PT services continued to receive them while 17.7% did not. Those who did not receive services lacked private insurance and were unwilling or unable to pay out-of-pocket fees. Clients who required services and accessed them were ten times more likely to report good health than those who required – but did not receive – services.

Evaluating and Improving Heart Disease Treatment in Canada
A new, CIHR-funded study will explore the quality and effectiveness of an increasingly popular treatment for heart disease, percutaneous coronary intervention (commonly known as angioplasty). Regional variations in its use and associated death rate point to a lack of knowledge about this procedure.

Study investigators, including HPME's David Alter, Peter Austin, Therese Stukel and Jack Tu, will answer the following questions: What is high quality care for percutaneous coronary interventions (PCI)? What is the current quality of care and what are the outcomes of PCI? What factors are associated with positive PCI outcomes? The researchers will develop PCI performance measures and evaluate the quality of PCI care in Ontario hospitals.


Knowledge Translation

New Low Back Pain Resources Now Available
As a core member in U of T's Knowledge Translation Program (KTP), HPME is promoting the dissemination of a new set of Acute Low Back Pain Resources for health care providers and patients. HPME is an active participant in the on-going translation of health services research knowledge to providers, managers and policymakers, and has a core research concentration in knowledge transfer. These resources promote the use of Acute Low Back Pain guidelines through a variety of methods, including on-line resources, patient education posters, prescription pads and pamphlets and a consumer education portal.


Events

Robyn Tamblyn Gives Keynote at HPME Research Day
On Wednesday May 2, 2007, Professor Robyn Tamblyn ( McGill University ) will speak at HPME Research Day. Dr. Tamblyn will share her groundbreaking research on the use of wireless technologies to improve clinical care and research. As Director of MOXXI (Medical Office of the Twenty First Century), Dr. Tamblyn's group developed a network that connects doctors and pharmacies through wireless handheld devices. The MOXXI network allows doctors to access patients' drug and medical histories instantly and is designed to reduce prescription errors and adverse drug reactions. Visit HPME Research Day for more information.

Education Day Focuses on Leadership Competencies
On Tuesday, May 15, 2007, the HPME Society of Graduates welcomes you to attend their annual Education Day. This year's theme is "Effective Leadership Competencies in a Changing Healthcare Context” and features Mr. Bob Murphy, former senior vice-president and administrator for Baptist Hospital in Pensacola, Florida. Mr. Murphy was part of a senior leadership team that brought Baptist's customer satisfaction rating from less than 20 percent to a consistent 99 percent over an eight-year period. He is currently a Studer Group National Speaker and Coach. This event is open to all health care providers, decision-makers and policymakers. Visit the HPME website for more information and to register.