Research

Dr. Berta and Dr. Laporte Embark on new Study of Operational Efficiency in LTC

Co-PIs Dr. Whitney Berta and Dr. Audrey Laporte, both Assistant Professor in HPME, and co-investigators Dr. Geoff Anderson and Dr. Vivian Valdmanis embark on a new study entitled "Operational Efficiencies of Long Term Care Facilities in Canada". This study investigates the relationships between inputs (and their costs) and operational efficiency, and what factors determine efficiency. As the proportion of the Canadian population which is elderly increases over the next few decades, the demand for institutional LTC is expected to increase beyond the system's current capacity. Unrealized service efficiencies may mitigate some of the effects of aging baby boomers on health expenditures. However, realizing these efficiencies is contingent upon identifying what the determinants of operational efficiency are, and how they are related to service quality.

The objectives of this study are to:

• Measure the operational efficiency of each LTC facility relative to the 'best performance' standard identified amongst facilities across Canada;
• Identify resident-, facility- and environment-level factors most closely associated with observed facility operational efficiency.

Results will provide decision-makers with information about which organizational structures and factors are most closely associated with greater efficiency. As such the findings can be used to inform improved decision-making and policy planning related to the provision of funds and allocation of resources to LTC facilities.

Recent Addition to Primary Care Performance Indicators Project Team

Dr. Pong of the Centre for Rural and Northern Health Research, Laurentian University has recently joined the Primary Care Performance Indicators Project (PCPIP). His research encompasses a number of related areas including studies on health status, health determinants, health human resources, and health services delivery (e.g. telehealth, outreach services) in rural/northern areas. He has conducted several major studies on the physician workforce including the 1997 and 2001 National Family Physician Surveys, the role of medical education in enhancing the rural medical workforce, and rural physician recruitment and retention. Dr. Pong has also conducted a multi-year tracking study of nurse practitioners in Ontario.

Dr. Jan Barnsley, HPME Associate Professor, is leading the study on the assessment of performance in family practice. Current project activities include the revision of four data collection instruments based on analysis of data quality and feedback from a Field Test of Primary Care Performance Indicators conducted in 10 family practice sites across Ontario. Once the revisions are completed, the instruments will be converted into an electronic version. Dr. Malcolm Koo (Assistant Professor, Department of Public Health Sciences) is providing assistance with this part of the project. For more information about the PCPIP, please contact Project Coordinator Judith MacPhail (email).

Jan Barnsley: Why Don't Patients See Their Regular Physicians During Acute Illness?

Dr. Jan Barnsley and co-author Dr. Maria Mathews (Assistant Professor, Division of Community Medicine, Memorial University of Newfoundland) had their article "Patients seeking care during acute illness. Why do they not see their regular physicians?" published in the November 2003 issue of the Canadian Family Physician. Based on data from the Ontario Walk-In Clinic Study, the researchers found that belief in continuity of care and greater distance to the doctor's office increased the likelihood of seeing their regular physicians, while recent hospitalization and difficulty seeing physicians during and after office hours decreased this likelihood. Almost half of the patients who preferred seeing their regular physicians for acute illness did not actually see their regular physicians.

Raisa Deber: Why did the WHO Rate Canada's Health System as 30th?

Dr. Raisa Deber's analysis of Canada's ranking in the World Health Organization (WHO) 2000 Report was pre-released in the Longwoods Review (Vol. 2, No. 1, 2003), "Why did the WHO rate Canada's health system as 30th? Some thoughts on League Tables". Dr. Deber concludes that the health system performance rankings were not based on actual measures of the health system functioning and that Canada's relatively low standing rests on the relatively high educational level of its population rather than on any features of its health system. Therefore the WHO 2000 rankings are not particularly helpful guides to measuring the performance of health systems.

Research and Teaching Profiles

Faculty associated with the Department of Health Policy, Management and Evaluation (HPME) are involved in a broad range of research activities with a variety of organizations. Success of the HPME Knowledge Transfer initiative is dependent on presenting our stakeholders with a unified, clear image of the depth and breadth of Departmental expertise. To promote greater internal awareness of the knowledge developed through HPME, faculty research profiles will be included as a regular feature of this newsletter.

This issue of the HPME newsletter features a research profile for Professor Peter C. Coyte.

+ + PROFILE OF THE MONTH + +

Peter C. Coyte, PhD

Peter Coyte is a Professor of Health Economics in the Department of HPME and Professor (status only) in the Faculty of Nursing at the University of Toronto. Dr. Coyte has published widely in the areas of health economics, health policy and health services research. His studies have included the measurement of regional variations in health service utilization, evaluations of the cost effective provision of health care services, and assessments of health service finance, delivery and organization.

Education and Work Background

Dr. Coyte completed his MA and PhD in Economics at the University of Western Ontario, where he received the T. Merritt Brown Prize from the Economics Department for the best PhD thesis of 1982. Prior to joining the University of Toronto in 1987, Dr. Coyte was an Associate Professor in the Economics Department at the University of Alberta and, before that, an Assistant Professor at Simon Fraser University, BC. Over the course of his research career, he has been engaged in collaborative research and knowledge translation activities with participants from industry, government and academia. In addition, Dr. Coyte has been retained as a consultant to various international, national and local organizations and has been an active participant in health policy debates.

In 2002, Dr. Coyte was elected President of the Canadian Health Economic Research Association (CHERA/ACRES) and he has been instrumental in championing the evolution of that organization to form the new Canadian Association for Health Services and Policy Research (CAHSPR/ACRSPS). This name change reflects the expansion of the organization's mandate from an exclusive focus on health economics to one that includes health services finance, organization, delivery, regulation and evaluation, as well as health policy analysis; and the expansion of the organization's membership base to include researchers, research-users, and policy makers with interests in the fields of: health economics, health services and outcomes research, epidemiology, behavioural science, biostatistics, the social sciences and humanities, political science, health care professional research, policy analysis, health law, health care ethics, research dissemination, health care management, and other related fields. This new multi-disciplinary membership-based association is dedicated to improving the quality, relevance and application of health services and policy research in Canada.

See Other Notables for details about the 1st CAHSPRA/ACRSPS conference in May 2004.

Research Activities

Dr. Coyte has an international reputation as a senior health researcher who has published on a variety of topics, including health economics, health services research, evaluative sciences and health policy. He has been recognized for his scholarly contributions through receipt of a CHSRF/CIHR Health Services Chair (2000-present), a CIHR Senior Investigator Award (2000), a Kappa Delta Award from the American Academy of Orthopaedic Surgeons (2002), and a Young Investigator Award from the Association of University Programs in Health Administration (1995).

Since 1997, Dr. Coyte has been engaged in a collaborative undertaking between Nursing and Medicine to form the Home and Community Care Evaluation and Research Centre (HCERC). HCERC's mission is to champion evaluation and policy development, foster a collaborative research network and to disseminate findings broadly. Activities have been undertaken to ensure success in fund-raising, increase awareness of home and community care research for decision-making, and to promote knowledge exchange between the research and decision-making communities.

In 2000, Peter Coyte was awarded a Chair in Health Services Research, entitled Health Care Settings and Canadians: A Program of Research, Education and Linkage. As a result, HCERC has been restructured to focus on the new technologically mediated and geographically dispersed health care order, and to form the hub for a new Strategic Research and Training Program in Health Care, Technology and Place (HCTP). This Program has attracted significant multi-year financial commitments from the Canadian Institutes of Health Research. It encompasses all four graduate divisions at the University of Toronto, with a vision to generate a cadre of humanistically informed scientists and scientifically informed humanists.

Teaching and Supervisory Responsibilities

Dr. Coyte has an excellent reputation as an educator. He plays a major role in research supervision to a large cadre of scholars. Many have their primary affiliations outside HPME, thereby demonstrating his experience as a transdisciplinary mentor and a proponent of translational research. Dr. Coyte is the Co-Director of the Health Care, Technology and Place Collaborative Doctoral Program, which provides mentorship in transdisciplinary research and bridges the knowledge gaps among doctoral students from participating departments who are concerned with the interconnectedness of bodies, technologies, places, and work in contemporary health care.

Four notable education and mentoring achievements include, Drs. Ungar (PhD), Hawker (MSc), Flood (SJD) & Laporte (Post-Doctoral Fellow):

• Dr. Wendy Ungar, Scientist, Hospital for Sick Children Research Institute and Assistant Professor, Department of HPME, University of Toronto.
• Dr. Gillian Hawker, Director, Clinical Epidemiology, Associate Professor & MRC Scientist, Departments of HPME & Medicine, University of Toronto.
• Dr. Colleen Flood, Associate Professor, Faculty of Law, University of Toronto.
• Dr. Audrey Laporte, Assistant Professor, Department of HPME, University of Toronto.

Future Research

More information on Dr. Coyte's future research and training programs can be found on these websites:

• Health Care Settings and Canadians: www.hcerc.utoronto.ca
• Health Care, Technology and Place: www.hctp.utoronto.ca

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